Archer Pharmacology - Reproductive/Maternity/Newborn

The nurse is teaching a group of students about Rho(D) Immune Globulin. It would be correct if the student states that this medication is indicated when? Select all that apply. A. delivering an Rh-positive infant. B. aborting an Rh-positive fetus. C. undergoing chorionic villus sampling. D. having a transvaginal ultrasound. E. non-stress testing (NST). Submit Answer

Explanation Choices A, B, and C are correct. Rho(D) Immune Globulin should be administered to Rh-negative women who have been exposed to Rh-positive blood. Such exposures may be linked to Delivering an Rh-positive infant Chorionic villus sampling Aborting an Rh-positive fetus Receiving accidental transfusion of Rh-positive blood Amniocentesis Intraabdominal trauma while carrying an Rh-positive fetus. Choices D and E are incorrect. Transvaginal ultrasound is not invasive and does not risk mixing maternal and fetal blood. Therefore, transabdominal ultrasound is not an indication to administer Rho(D) Immune Globulin. Rho(D) Immune Globulin is not indicated for noninvasive antepartum testing, such as a non-stress test (NST). Learning Objective Understand the indications of administering RhoGAM. Additional Info Source : Archer Review Rh isoimmunization (Rh alloimmunization/ Rh sensitization) is a phenomenon in which an Rh-negative mother develops anti-D antibodies against Rh-positive fetal RBCs. In these cases, the Rh antigen on the fetal RBCs is acquired from paternal inheritance. Fetomaternal hemorrhage during a prior pregnancy, trauma, abortion, or any invasive procedure (e.g., chorionic villus sampling, amniocentesis) may expose an Rh negative maternal circulation to Rh positive fetal RBCs resulting in the development of antibodies. These antibodies do not affect the firstborn child. However, subsequent newborns can develop hemolytic disease. In at-risk mothers, isoimmunization can be prevented by administering Rh immune globulin or anti-D immunoglobulin (RhoGAM). RhoGAM prevents the production of anti-Rho(D) antibodies in Rh-negative women who have been exposed to Rh-positive blood. RhoGAM acts by suppressing the immune reaction of the Rh-negative woman to the antigen in Rh-positive blood, preventing antibody response and thereby preventing hemolytic disease of the newborn in future Rh-positive pregnancies. A failure to administer or delay in giving RhoGAM can destroy fetal RBCs, leading to hemolytic disease in the newborn. Important points to note before administering RhoGAM:- Type and antibody screening of the mother's blood and cord blood type of the newborn should be performed to determine the need for the medication. The mother must be Rh-negative and negative for Rh antibodies. The newborn must be Rh-positive. In the event of termination of pregnancy, if the fetal blood type is uncertain, RhoGAM should be administered to an Rh-negative mother. The newborn might have a weakly positive antibody test if the woman received Rho(D) immune globulin during pregnancy. The drug is administered to the mother, not the infant. The deltoid muscle is recommended for intramuscular administration. The medication may be given intravenously if prescribed. Last Updated - 01, Feb 2023

The client admitted to the gynecology ward for premature labor is given terbutaline to arrest labor. The nurse should monitor which of the following parameters when administering this medication? A. Breath sounds [44%] B. Urine output [14%] C. Pain [6%] D. Level of consciousness

Explanation Choice A is correct. Although rare, one of terbutaline's most serious adverse effects is pulmonary edema. The nurse should monitor the client's breath sounds and assess for respiratory crackles and difficulty breathing to detect if pulmonary edema is present. Choice B is incorrect. Terbutaline does not affect a client's urine output. Choice C is incorrect. Terbutaline is a tocolytic agent. It arrests labor and uterine contractions, likely decreasing the client's pain levels. Although the medication may decrease or alleviate the client's labor pain, this is not the nurse's priority assessment. Choice D is incorrect. Terbutaline does not have any effect on a client's level of consciousness. Learning Objective When caring for a client receiving terbutaline to arrest premature labor, recognize the need to assess the client's breath sounds to monitor signs and symptoms of pulmonary edema, an adverse side effect of terbutaline administration. Additional Info If terbutaline-related pulmonary edema develops, the condition will generally develop within 72 hours of the initiation of the drug therapy. Pulmonary edema typically resolves within 24 hours of the discontinuation of the medication. Last Updated - 28, Nov 2022

The nurse is caring for a client experiencing labor dystocia. Which medication does the nurse anticipate from the primary healthcare provider (PHCP)? A. Oxytocin B. Terbutaline C. Magnesium sulfate D. Betamethasone Submit Answer

Explanation Choice A is correct. Labor dystocia is a broad term indicating difficult labor that is not progressing. One of the medications that may be used to assist in labor progression is oxytocin. This medication stimulates uterine contractions. Choices B, C, and D are incorrect. Terbutaline is a tocolytic and is used to suppress uterine contractions. This medication would further decrease the progress of labor. Magnesium sulfate is a medication used in preterm labor to help stop contractions. It would be contraindicated in the client experiencing labor dystocia. Betamethasone is a steroid administered to mothers in preterm labor to help the development of the fetus's lungs in anticipation of preterm delivery. This medication is not indicated for labor dystocia. Additional Info Labor dystocia describes difficult labor that does not progress as expected. During labor dystocia, uterine contractions are not effective or infrequent. Management of labor dystocia includes Administration of intravenous (IV) or oral fluids to correct any electrolyte imbalances. Frequent maternal position changes. Standing or sitting in a warm shower can be therapeutic. Pain management is important; however, epidural blocks decrease labor progress. Prescriptive treatments such as oxytocin may be used. Last Updated - 18, Sep 2022

A client presents to the clinic asking the nurse about emergency contraception. The nurse anticipates that the primary healthcare provider (PHCP) will prescribe which medication? A. Levonorgestrel B. Tamoxifen C. Finasteride D. Methotrexate Submit Answer

Explanation Choice A is correct. Levonorgestrel (LNG) is available over the counter for emergency contraception. This medication is indicated to be used up to 72 hours following unprotected intercourse, where pregnancy could be possible. It may be used off-label up to 120 hours following the event. This medication works by postponing (or inhibiting) ovulation. Choices B, C, and D are incorrect. These medications are not indicated as emergency contraception. ➢ Tamoxifen is indicated for hormone receptor-positive breast cancer. This medication is used to prevent breast cancer recurrence. ➢ Finasteride is indicated for benign prostatic hyperplasia. This medication is highly teratogenic and should be handled with gloves by pregnant women. ➢ Methotrexate is indicated for ectopic pregnancy that has not ruptured. This may be an alternative to surgery. Additional Info Several methods may be used for emergency contraception (EC). The most commonly used are - Levonorgestrel (LNG) is an oral pill that may be taken 72-120 hours following unprotected intercourse. This medication is available without a prescription. Abdominal cramping, fatigue, vaginal bleeding/spotting. Copper IUD is the most effective form of EC because it may be placed for up to five days following unprotected intercourse. Some prescribers may place this device ten days after unprotected intercourse if specific criteria have been met. A significant disadvantage is that a practitioner must place this device. The client may keep this device inserted to prevent future pregnancies. The current guideline is that this device must be removed and replaced after ten years. Last Updated - 10, Nov 2022

The nurse is caring for a client newly diagnosed with mastitis. The nurse anticipates a prescription for which medication? A. Cephalexin B. Acyclovir C. Fluconazole D. Imiquimod Submit Answer

Explanation Choice A is correct. Mastitis is commonly caused by Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and streptococci. Thus, antibiotics such as cephalexin are effective in the treatment of mastitis. Choices B, C, and D are incorrect. Mastitis responds to antibiotic therapy. Acyclovir is an antiviral and not indicated in the treatment of mastitis. Fluconazole is an antifungal. Imiquimod is indicated in the treatment of genital warts and certain skin cancers. Additional Info ✓ Mastitis is often caused by Staphylococcus aureus, methicillin-resistant Staphylococcus aureus (MRSA), E. coli, and streptococci. ✓ The bacteria are most often carried on the skin of the mother or in the mouth or the nose of the newborn. ✓ The organism enters through an injured area on the nipple, such as a crack or blister. ✓ The primary medical treatment is antibiotics and continued emptying of the breast. ✓ Comfort measures during mastitis include applying moist heat or ice packs, breast support, bed rest, fluids, and analgesics. Last Updated - 30, Jan 2023

The nurse is counseling a group of students on the dosing schedule of Rho(D) Immune Globulin. It would indicate effective understanding if the student states that Rho(D) Immune Globulin should be administered at A. 12 weeks of pregnancy and within 72 hours of delivery. B. 28 weeks of pregnancy and within 72 hours of delivery. C. 25 weeks of pregnancy and within 96 hours of delivery. D. 16 weeks of pregnancy and within 12 hours of delivery. Submit Answer

Explanation Choice B is correct. Guidelines recommend administering Rho(D) Immune Globulin at 28 weeks of pregnancy and within 72 hours of delivery. Maternal sensitization occurs in approximately 72 hours following the exposure of material circulation to the Rh-positive fetal RBCs. Giving Rho(D) Immune Globulin (RhoGAM) too early will not provide adequate prophylaxis against Rh isoimmunization. Giving RhoGAM after 28 weeks of gestation would be too late to prevent isoimmunization during pregnancy because Rh antibodies have already formed. Choices A, C, and D are incorrect. These time frames are incorrect for administering Rho(D) Immune Globulin. Learning Objective Recognize the correct timing for administering RhoGAM. A failure to administer or delay in giving RhoGAM may result in the destruction of fetal RBCs, leading to hemolytic disease in the newborn. Additional Info One standard dose of Rho(D) Immune Globulin is administered IM or IV push: At 28 weeks of pregnancy and within 72 hours of delivery of an Rh-positive infant, undergoing chorionic villus sampling, amniocentesis, or intraabdominal trauma. Within 72 hours after termination of a pregnancy of 13 weeks or more of gestation. Last Updated - 09, Jul 2022

The nurse is caring for a client with an ectopic pregnancy. The primary healthcare provider (PHCP) recommends medical treatment over surgical treatment. The nurse anticipates a prescription for which medication? A. Terbutaline B. Methotrexate C. Methylergonovine D. Nifedipine Submit Answer

Explanation Choice B is correct. Methotrexate (MTX) may be used to medically treat an ectopic pregnancy that has not ruptured, and the woman is hemodynamically stable. Methotrexate is a folic acid antagonist and may be given a variety of routes. Choices A, C, and D are incorrect. Terbutaline and nifedipine are tocolytics employed in the prevention of preterm labor. Methylergonovine is an ergot alkaloid indicated in the treatment of postpartum hemorrhage. None of these medications are indicated for an ectopic pregnancy. Additional Info An ectopic pregnancy is an extrauterine pregnancy. Almost all ectopic pregnancies occur in the fallopian tube. Criteria for a woman to be treated with MTX versus surgery are the following: Hemodynamically stable Have no renal, hepatic, or hematologic disorders Able and willing to attend post-treatment appointments and have access to medical care in case of a ruptured fallopian tube Pretreatment serum human chorionic gonadotropin (hCG) concentration ≤5000 milli-international units/mL No fetal cardiac activity on transvaginal ultrasound Methotrexate is a chemotherapeutic agent. Facility protocols for chemotherapy should be followed, including appropriate personal protective equipment (double glove). Air should not be expelled from the syringe because it could aerosolize the medication. The woman should be taught that her urine is considered toxic for 72 hours. She should be careful to avoid getting urine on the toilet seat. The toilet should be flushed twice with the lid closed when she voids. Transient abdominal pain occurs during methotrexate therapy, probably because of the expulsion of the products of conception from the tube. Last Updated - 03, Jul 2022

The nurse is caring for a client who is receiving prescribed methylergonovine. Which of the following client findings would indicate a therapeutic response? A. Increased blood pressure B. Decreased post-partum bleeding C. Decreased uterine tone D. Increased urinary output Submit Answer

Explanation Choice B is correct. Methylergonovine is an alkaloid medication used to manage postpartum hemorrhage (PPH). This medication causes vasoconstriction, therefore, decreasing postpartum bleeding. Choices A, C, and D are incorrect. The most common adverse effect associated with this medication is hypertension. This is due to the medication's vasoconstrictive effects. The medication therapeutically should cause an increase in uterine tone, therefore, reducing bleeding. This medication would not directly impact urinary output. Additional Info ✓ PPH may be treated with oxytocin, misoprostol, and/or methylergonovine. ✓ These medications specifically work by contracting the uterus and decreasing bleeding. ✓ The nurse should monitor the client's cardiovascular status closely while taking this medication because of the risk of severe hypertension. ✓ This medication is given intramuscularly (IM). Last Updated - 31, Dec 2022

A 15-year-old female comes into the gynecology clinic asking for an oral contraceptive pills prescription. Fifteen minutes later, her mother comes in and scolds the teenager about her decision. She tells the doctor not to give her daughter the pills because she is still too young. What should be the most appropriate action by the nurse? A. Withdraw the prescription for contraceptive pills. B. Call Child Protective Services. C. Explain to the mother that in cases of birth control services, her daughter has the right to give consent on her own. D. Explain to the teenager that her mother still has consenting authority over her decisions. Submit Answer

Explanation Choice C is correct. When the minor is seeking birth control treatments, the minor's consent is sufficient and does not warrant the permission of her parents. Choice A is incorrect. Parental or guardian consent should be obtained before treatment is initiated for a minor except in an emergency. There are certain situations in which the permission of the minor is sufficient enough, i.e. birth control treatments. Choice B is incorrect. There is no sign of abuse; the nurse does not need to call child protective services. Choice D is incorrect. The mother no longer has consenting authority over her child when it comes to birth control treatments. Last Updated - 12, Dec 2021

The nurse is caring for a client in premature labor receiving a terbutaline infusion. All of the following manifestations would alert the nurse to stop the infusion, except: A. Blood pressure of 91/58 mmHg B. Heart rate of 132 beats/minute C. Serum potassium level of 3.3 mEq/L D. Blood glucose level of 130 mg/dL Submit Answer

Explanation Choice D is correct. Terbutaline may increase the client's blood glucose level. The nurse should monitor the client's blood sugar levels while on this medication. Since the client has been receiving the terbutaline and is currently at 130 mg/dL, this blood glucose value seems an acceptable value to continue terbutaline infusion. Choice A is incorrect. Terbutaline is a beta-agonist. By acting on beta-2 receptors in vascular smooth muscle, this medication causes vasodilation. Hypotension is an adverse effect of terbutaline. The nurse should stop the infusion when the blood pressure drops below 90/60 mmHg. As such, the nurse would have discontinued the infusion based on the client's blood pressure of 91/58. Choice B is incorrect. By acting on beta-1 receptors in the heart, terbutaline increases the heart rate, causing tachycardia, one of the well-documented adverse effects of this medication. The nurse should stop the infusion when the client's heart rate is more than 120 bpm. As such, the nurse would have stopped the infusion based on the client's heart rate of 132/bpm. Choice C is incorrect. Hypokalemia is another adverse effect of terbutaline. A serum potassium level of less than 3.5 mEq/L is considered hypokalemia. Here, the client's potassium is 3.3 mEq/L. The client's hypokalemia should alert the nurse to stop the terbutaline infusion. Learning Objective Identify the client with a blood glucose of 130 mg/dL as the client who may continue to receive the terbutaline infusion. Additional Info Terbutaline has been used systemically off-label to reduce contractions of preterm labor and uterine hyperstimulation. Terbutaline injection has not been approved and should not be used for prolonged tocolysis (beyond 48 to 72 hours). Serious adverse reactions, including death, have been reported after administering terbutaline sulfate to pregnant women. Adverse reactions include tachycardia, transient hyperglycemia, hypokalemia, cardiac arrhythmias, pulmonary edema, and myocardial ischemia. Increased fetal heart rate and neonatal hypoglycemia may occur as a result of maternal administration. Last Updated - 09, Jan 2023

The nurse is preparing to obtain a prescription for Rho(D) Immune Globulin. The nurse understands that this medication may be administered through which route? Select all that apply. A. Intradermal B. Intramuscular C. Subcutaneously D. Oral E. Intravenous Submit Answer

Explanation Choices B and E are correct. Most commonly, Rho(D) Immune Globulin is given intramuscular (IM); however, if the client has a patent peripheral vascular access device and the prescriber agrees, the medication may be given intravenously to minimize the discomfort associated with IM injections. Choices A, C, and D are incorrect. The only route to administer Rho(D) Immune Globulin is IM or IV. Additional Info Rh immune globulin (RhoGAM) prevents the production of anti-Rho(D) antibodies in Rh-negative women who have been exposed to Rh-positive blood by suppressing the immune reaction of the Rh-negative woman to the antigen in Rh-positive blood; preventing antibody response and thereby preventing hemolytic disease of the newborn in future Rh-positive pregnancies. Type and antibody screening of the mother's blood and cord blood type of the newborn should be performed to determine the need for the medication. The mother must be Rh-negative and negative for Rh antibodies. The newborn must be Rh-positive. If the fetal blood type after the termination of pregnancy is uncertain, the medication should be administered. The newborn might have a weakly positive antibody test if the woman received Rho(D) immune globulin during pregnancy. The drug is administered to the mother, not the infant. The deltoid muscle is recommended for intramuscular administration. The medication may be given intravenously if prescribed. Last Updated - 01, Jan 2023

The nurse is preparing to administer a prescribed infusion of oxytocin to a client with labor dystocia. During the infusion, the nurse plans to monitor which of the following? Select all that apply. A. Deep tendon reflexes (DTR) B. Fetal heart rate (FHR) patterns C. Uterine activity (UA) D. Blood pressure (BP) E. Urine specific gravity (USG) Submit Answer

Explanation Choices B, C, and D are correct. FHR patterns, UA, and BP are three monitoring parameters essential to monitor an infusion of oxytocin. Oxytocin may cause nonreassuring FHR patterns such as tachycardia, bradycardia, decreased variability, and pathologic (late, variable, or prolonged) decelerations. Oxytocin may cause excessive uterine activity (UA) (tachysystole, hypertonus, inadequate relaxation time). Rapid infusion of oxytocin may cause maternal hypotension. BP monitoring is recommended. Choices A and E are incorrect. DTRs are not necessary to monitor during an oxytocin infusion. This would be applicable for the infusion of magnesium sulfate as magnesium sulfate is a muscle relaxant. USG has no relevance to the infusion of oxytocin. Additional Info Oxytocin Medication Administration Guidelines Must be administered via an infusion pump Avoid rapid infusion as this may cause hypotension Adverse maternal reactions include excessive uterine activity (UA) (tachysystole, hypertonus, inadequate relaxation time, etc.), impaired uterine blood flow, uterine rupture, and placental abruption Adverse fetal reactions include fetal bradycardia, fetal tachycardia, reduced FHR variability, and late or prolonged decelerations Discontinue infusion for any nonreassuring fetal heart rate pattern Last Updated - 08, Dec 202