ch 6

A pregnant woman states that she has been constipated since becoming pregnant. Which medication is most appropriate for preventing constipation related to pregnancy? A) Metamucil B) Mineral oil C) Saline cathartic D) Stimulant cathartic

Ans: A Feedback: A bulk-producing agent, such as Metamucil, is most physiologic for the mother and safe for the fetus. Mineral oil is not recommended because of the lack of absorption of fat-soluble vitamins. Saline cathartics are not recommended because of hypernatremia. Stimulant cathartics are not recommended for the pregnant woman.

A pregnant woman is experiencing nausea and vomiting in her first trimester of pregnancy. Which herbal agent has traditionally been used as an antiemetic? A) Ginger B) Garlic C) Ginkgo biloba D) Green tea

Ans: A Feedback: Ginger has been used to relieve nausea and vomiting during pregnancy. Garlic, Ginkgo biloba, and green tea are not recommended to relieve nausea and vomiting in pregnancy.

A woman was administered misoprostol (Cytotec) in an effort to induce labor, but the care team is unsatisfied with the results. Consequently, oxytocin will be used. Prior to administering oxytocin, what must occur? A) Four hours must elapse after the last dose of misoprostol. B) The woman must have a type and cross-match performed. C) The woman must receive a bolus of 500-mL normal saline. D) The woman must have her electrolytes measured.

Ans: A Feedback: If the course of treatment changes and oxytocin is to be given after misoprostol, it is essential to wait 4 hours from the last administration of misoprostol before starting oxytocin. Blood work and IV hydration are not necessary.

A woman who is in the first trimester of her pregnancy has told the nurse, "I've stopped taking my blood pressure pill because I know it could harm the baby. Instead, I've started taking natural and herbal remedies." What nursing diagnosis is suggested by the woman's statement? A) Deficient knowledge related to drug and herbal effects during pregnancy B) Health-seeking behaviors related to protection of fetal health C) Acute confusion related to the potential teratogenic effects of herbs D) Effective therapeutic regimen management related to use of herbs rather than drugs

Ans: A Feedback: This patient is evidently unaware of the fact that herbs pose risks to her fetus and that such risks are not limited to drugs. The nurse should address this knowledge gap. Acute confusion suggests a deficit in cognitive processes, not a lack of relevant and accurate information.

A couple have been trying unsuccessfully for nearly a year to become pregnant and have now sought fertility counseling. The nurse should be aware of what potential etiological factors related to infertility? Select all that apply. A) Absence of sperm B) Endometriosis C) Vaginitis D) Blocked fallopian tubes E) Fibromyalgia

Ans: A, B, D Feedback: In women, the most common causes are ovulation disorders, blocked fallopian tubes, endometriosis, and advanced maternal age, which affects egg quality and quantity. In men, causes include absence of sperm, declining sperm counts, testicular abnormalities, and ejaculatory dysfunction. Vaginitis cannot cause infertility, and fibromyalgia is not noted as a common etiological factor.

A pregnant woman asks why she needs to take a folic acid supplement. What is the nurse's best explanation for the administration of folic acid? A) "Folic acid prevents the development of contractions." B) "Folic acid prevents neural tube birth defects." C) "Folic acid builds strong fetal bones." D) "Folic acid will decrease nausea and vomiting."

Ans: B Feedback: Folic acid prevents neural tube birth defects. Folic acid does not prevent contractions. Folic acid will not build fetal bones. Folic acid will not prevent nausea and vomiting.

A patient is receiving oxytocin (Pitocin). Which of the following is a maternal adverse effect of Pitocin? A) Acute confusion B) Hypertension C) Edema D) Inverted T wave

Ans: B Feedback: Hypertension is a maternal adverse effect of Pitocin. Confusion, edema, and inverted T wave are not adverse effects of Pitocin.

A woman in labor is being treated with magnesium sulfate intravenously and is beginning to show signs and symptoms of hypermagnesemia. The infusion has been discontinued, and the nurse should anticipate administration of what drug? A) Metoprolol (Lopressor) B) Calcium gluconate C) Potassium chloride D) Furosemide (Lasix)

Ans: B Feedback: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. Calcium gluconate, the antidote for magnesium sulfate, should be readily available for use if hypermagnesemia occurs.

When administering magnesium sulfate, for what should the nurse assess the patient? A) Dry, pale skin B) Respiratory depression C) Agitation D) Tachycardia

Ans: B Feedback: Overdoses of magnesium sulfate may lead to hypotension, muscle paralysis, respiratory depression, and cardiac arrest. The nurse would not anticipate dry, pale skin; agitation; or tachycardia.

A woman who is 7 months pregnant is waking up at night with gastroesophageal reflux. Which of the following medications is most highly recommended? A) Terbutaline (Brethine) B) Diphenoxylate (Lomotil) C) Ranitidine (Zantac) D) Chlorothiazide (Diuril)

Ans: C Feedback: A histamine2 receptor antagonist, such as ranitidine, is used for gastroesophageal reflux disease. Terbutaline is a tocolytic agent. Diphenoxylate is not administered for GERD. Chlorothiazide is a diuretic agent.

A woman who takes highly active antiretroviral therapy (HAART) for HIV/AIDS has become pregnant. What effect will the woman's pregnancy have on her drug regimen? A) She must discontinue HAART due to the risk of teratogenic effects. B) Her dosages of HAART must be increased to reduce the risk of in utero transmission. C) She can continue her HAART unchanged. D) Some components of her HAART must be replaced or discontinued.

Ans: C Feedback: Antiretroviral drug therapy for the pregnant woman reduces perinatal transmission by about two thirds. In general, highly active antiretroviral therapy, or HAART, is safe, with recommended dosage the same as for nonpregnant women.

A nurse is performing health education with a woman who has just learned that she is pregnant. The nurse has explained the concept of teratogenic drugs and emphasized the need to have her care provider assess any medications she should consider taking. The nurse should teach the woman that drug-induced teratogenicity is most likely to occur at what point in her pregnancy? A) During the second half of her third trimester B) In the 7 to 10 days after conception C) In the first trimester during organogenesis D) During 30 to 34 weeks of gestation

Ans: C Feedback: Drug-induced teratogenicity is most likely to occur when drugs are taken during the first three months of pregnancy, during organogenesis.

A woman has been unable to conceive for many months and will soon begin treatment with clomiphene (Clomid). What health education should the nurse provide to this patient? A) Avoid drinking alcohol while taking Clomid. B) Perform daily OTC pregnancy tests beginning the day after taking Clomid. C) Take her basal temperature between 5 to 10 days after taking Clomid. D) Report any numbness or tingling in her hands or lips to her care provider.

Ans: C Feedback: Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. There is no specific contraindication against alcohol, and neurological adverse effects are not expected.

A woman is being administered IV magnesium sulfate. What is a desired outcome related to the administration of magnesium sulfate? A) Increased contractions B) Respiratory rate above 18 C) Decreased blood pressure D) Increased uterine tone

Ans: C Feedback: The administration of magnesium sulfate can prevent seizure activity and reduce severe hypertension. Magnesium sulfate is administered for preterm labor to prevent contractions and reduce uterine tone, not to increase respiratory rate.

A woman who began labor several hours ago is to be administered oxytocin. What is the goal of oxytocin therapy? A) Prevent postpartum bleeding B) Decrease fetal hyperactivity C) Augment weak or irregular contractions D) Diminish periods of relaxation

Ans: C Feedback: Use of this manufactured hormone induces labor or augments weak, irregular uterine contractions during labor. It is not used in the labor phase to prevent bleeding. It is not administered to decrease fetal hyperactivity. The administration of oxytocin should allow for adequate periods of relaxation between contractions.

A primiparous woman was vigilant in avoiding medications and herbs during her pregnancy and states that she is similarly committed to protecting her baby's health now that she is breast-feeding. What principle should guide the woman's use of medications while breast-feeding? A) Very few medications are explicitly contraindicated while breast-feeding. B) It is generally safer to use herbs rather than medications while breast-feeding. C) Most women can resume their prepregnancy medication regimen after delivery. D) Most medications are contraindicated while a woman is breast-feeding.

Ans: D Feedback: A wide variety of medications are contraindicated during pregnancy, and herbs are not guaranteed to be safe.

A woman is at 42 weeks of gestation. Which of the following medications will be administered to promote cervical ripening? A) Calcium gluconate B) Magnesium sulfate C) Terbutaline (Brethine) D) Dinoprostone (Cervidil)

Ans: D Feedback: Cervidil is administered to ripen the cervix in a woman who is at 42 weeks of gestation. Calcium gluconate, magnesium sulfate, and terbutaline are not administered to ripen the cervix.

A patient is being administered magnesium sulfate for preterm labor. The patient's serum magnesium level is elevated at 11 mg/dL. With what sign or symptom will the patient likely present? A) Tachypnea B) Muscle rigidity C) Tachycardia D) Depressed deep tendon reflexes

Ans: D Feedback: Hypermagnesemia will cause depressed deep tendon reflexes. The serum magnesium level of 11 mg/dL would result in depressed respirations. The serum magnesium level of 11 would result in decreased muscle strength. The serum level of 11 mg/dL would result in bradycardia, not tachycardia.

A patient is being treated for preterm labor. Which beta-adrenergic medication is administered orally to decrease uterine contractions? A) Magnesium sulfate B) Oxytocin (Pitocin) C) Nifedipine (Procardia) D) Terbutaline (Brethine)

Ans: D Feedback: Terbutaline is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels; oral doses can be given as maintenance therapy. Magnesium sulfate is administered intravenously and not administered at home. Oxytocin induces labor. Nifedipine is a calcium channel blocker that decreases uterine contractions.

A woman in preterm labor has been administered terbutaline sulfate (Brethine). For what potential adverse effects should the nurse assess the patient? A) Pruritus (itching) and copious diaphoresis B) Joint pain and numbness in her extremities C) Headache and visual disturbances D) Palpitations and shortness of breath

Ans: D Feedback: Terbutaline sulfate (Brethine) is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Adverse effects may include hyperkalemia, hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women commonly experience hand tremors, palpitations, and shortness of breath with chest tightness.