Chapter 46: Uterine Drugs PrepU
3 See full question 10s A nursing student is studying drugs used to prevent uterine contractions. She correctly identifies this class of drugs to be which of the following?
tocolytics Explanation: Tocolytics are drugs used to prevent uterine contractions. Oxytocics are drugs used to induce uterine contractions. The cytotoxics are drugs used to treat malignancies by causing cell death or preventing cell replication. The antineoplastics also are drugs used to control or kill neoplastic cells. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
8 See full question 13s A client who just gave birth begins to show signs of uterine atony and is not responding to oxytocin. The nurse anticipates administration of which drug?
methylergonovine Explanation: Methylergonovine is used for postpartum uterine atony as well as hemorrhage. The other drugs are tocolytics, which are used for preterm labor to stop contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
18 See full question 1m 22s The nurse is caring for a woman who is 35 weeks gestation with severe eclampsia. The nurse knows that magnesium is administered to this client for what reason?
Prevent seizures Explanation: Magnesium was once used to decrease uterine contractions but is now most commonly used to decrease the chance of seizures in clients with preeclampsia or eclampsia. It does not have any effect on the edema, headache, or protein in the urine. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 542. Chapter 46: Uterine Drugs - Page 542 Add a Note
12 See full question 55s A client who is 30 weeks' pregnant has come to the labor and delivery unit with contractions. The health care provider orders magnesium to decrease the contractions. The client is very upset and persistently seeking reassurance that the baby is safe. The highest priority nursing diagnosis for this client is:
anxiety. Explanation: The highest priority nursing diagnosis for this client is anxiety related to fears concerning the preterm labor. The others do not apply based on the data given. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
10 See full question 29s The nurse is aware of the risk for developing water intoxication with administration of intravenous (IV) oxytocin. Which of the following are signs of this adverse reaction that need to be reported immediately? (Select all that apply.)
drowsiness confusion headache wheezing and coughing rapid breathing Explanation: Water intoxication is a serious adverse reaction that can occur with IV oxytocin administration, especially if the drug is administered continuously. The nurse immediately reports any signs of water intoxication that include drowsiness, confusion, headache, listlessness, wheezing, coughing, and rapid breathing. Increased blood sugar levels are not related to the use of oxytocin, however a rise in the serum level can be seen during labor as a result of the body's stress response. Although not urgent, the nurse should note this change in the patient's status and monitor. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
13 See full question 34s A physician ordered intramuscular (IM) methylergonovine 0.2 mg for bleeding. It comes in a prefilled syringe of 0.4 mg in 0.5 mL. How much should the nurse give the client?
0.25 mL Explanation: The medicine comes in a prefilled syringe of 0.4 mg in a 0.5 mL syringe. The physician ordered a dose of 0.2 mg (half of the total syringe), so the nurse should give 0.25 mL. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
7 See full question 17s The use of oxytocin to induce labor would be contraindicated for all but which client?
A 25-year-old with diabetes mellitus Explanation: Oxytocin is contraindicated in cephalopelvic disproportion (fetal head relative to maternal pelvis) and with unfavorable fetal positions or presentations that must be converted before delivery (such as transverse lie). Contraindications for vaginal delivery include invasive cervical carcinoma, active genital herpes, cord presentation or prolapse, total placenta previa, and vas previa. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
4 See full question 19s How do premixed solutions of oxytocin prevent client errors?
All clients are using the same dilution in a solution. Explanation: Premixed solutions help to prevent errors because all clients are using the same dilution in a solution. It does not work uniformly in all clients and it requires the use of an electronic infusion device, as well as fetal and contraction monitoring. The nurse should always check the bag of solution before using it. Assessment and monitoring if any medication given in labor are required regularly.
2 See full question 16s A female client began an infusion of oxytocin 2 hours ago and the nurse has been conducting regular assessments on her as well as monitoring the fetal heart rate closely. The nurse should prioritize which potential nursing diagnosis in the organization of the client's immediate care?
Excess fluid volume Explanation: There are numerous potentially adverse effects associated with the use of oxytocin. Paramount among these, however, is the risk of excess fluid volume and water intoxication. This risk supersedes the potential for respiratory, cognitive, or thermoregulatory problems. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545. Chapter 46: Uterine Drugs - Page 545 Add a Note
17 See full question 17s The nurse is monitoring a client with eclampsia who is receiving magnesium. The nurse knows that the adverse reactions are associated with what electrolyte imbalance?
Hypocalcemia Explanation: The adverse reactions associated with IV magnesium therapy are related to hypocalcemia, not hypokalemia, hypernatremia, or hyperphosphatemia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
14 See full question 21s The labor and delivery nurse is preparing to give oxytocin to a client to induce labor. What should be the greatest cause for concern for the nurse if the client starts to exhibit it?
Large change in blood pressure Explanation: When administering pitocin to the client to promote labor, the nurse should be concerned if there is a big change in blood pressure. This finding could indicate a big problem. Other concerning adverse reactions would be cardiac arrhythmias and anaphylactic reactions. Having the sensation of nausea without vomiting is unpleasant but is not a serious threat to the client and can be treated. A change in comfort level is expected whenever someone is going through labor. Voicing exhaustion and wanting labor to be over is a universal feeling for all women during the birthing period. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
18 See full question 1m 28s The nurse knows to perform which priority nursing intervention if maternal hypotension is noted after administration of a tocolytic?
Move the client into the left lateral position. Explanation: If maternal hypotension is noted after the administration of a tocolytic, the nurse should immediately place the client in the left lateral position and notify the health care provider. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547. Chapter 46: Uterine Drugs - Page 547 Add a Note
16 See full question 40s The nurse knows that oxytocin is contraindicated in what obstetrical conditions? Select all that apply.
Placenta previa Cephalopelvic disproportion Hypertonic uterus Explanation: Oxytocin is contraindicated in cephalopelvic disproportion, unfavorable fetal position, severe preeclampsia, eclampsia, hypertonic uterus, and placenta previa. It is indicated for early delivery of a woman with a large fetus, Rh problems, premature rupture of membranes, and uterine inertia. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, pp. 543-544. Chapter 46: Uterine Drugs - Page 543-544 Add a Note
5 See full question 18s The labor and delivery nurse has administered an oxytocin for which reason(s)? (Select all that apply.)
Starting labor Improving labor Fetal problems Maternal problems Explanation: Oxytocin is administered to start or improve labor and to facilitate a timely vaginal delievery. Early vaginal delievery may be indicated when there are fetal or maternal problems. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
19 See full question 19s The nurse monitors the client receiving IV magnesium for what adverse effects? Select all that apply.
Sweating Flaccid paralysis Double vision Explanation: Adverse reactions of magnesium include dizziness, double vision, nausea/ vomiting, sweating, hypotension, depressed reflexes, and flaccid paralysis. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
9 See full question 15s The nurse is caring for a woman who is 30 weeks gestation and has just begun to experience uterine contractions. Which tocolytic drug does the nurse know will not be considered in the treatment of this client because of the client's gestational age?
Terbutaline Explanation: The use of terbutaline for more than 48 hours or in the home setting is not advised. Because the client is 30 weeks, tocolytic therapy will need to be continued for up to seven weeks. Magnesium, indomethacin, and nifedipine could also be used for more than 48 hours. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
12 See full question 59s While monitoring a woman who is receiving IV oxytocin for induction of labor, what event would cause the nurse to contact the health care provider immediately?
The uterine contractions are occuring every 90 seconds. Explanation: The health care provider should be notified immediately if there is a marked change in the frequency, rate, or rhythm of uterine contractions; uterine contractions that last more than 60 seconds; and contractions occurring more frequently than every 2-3 minutes. The client's blood pressure and pulse are within normal limits and the fetal heart rate is within normal limits. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
13 See full question 12s The nurse anticipates the health care provider will order methylergonovine for which purpose?
To contract the uterus after delivery of the placenta Explanation: Methylergonovine is not used before delivery of the placenta. Its purpose is to contract the uterus after delivery of the placenta and reduce postpartum bleeding. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545. Chapter 46: Uterine Drugs - Page 545 Add a Note
11 See full question 24s The labor and delivery nurse administers carboprost to a client after delievery of the placenta. Why does the nurse do this?
To prevent postpartum hemorrhage Explanation: Uterine stimulants increase the strength, duration, and frequency of uterine contractions and decrease the incidence of uterine bleeding. They are given after the delivery of the placenta and are used to prevent postpartum and postabortal hemorrhage caused by uterine atony. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
20 See full question 12s The nurse anticipates that the health care provider will order carboprost to treat which condition related to labor and delivery?
Uterine atony Explanation: Carboprost is used to treat postpartum hemorrhage caused by uterine atony. It is not indicated for cervical ripening, labor induction, or postpartum infection.
4 See full question 44s The nursing student is learning about the uses of oxytocin. The student demonstrates further understanding of this hormone when labelling which of the following as other effects of oxytocin? (Select all that apply.)
Antidiuretic effects Vasopressor effects Explanation: Oxytocin is a hormone with uterus-stimulating properties that act on the smooth muscle, especially in pregnancy. As pregnancy progresses, the sensitivity of the uterus to oxytocin increases. Oxytocin also has antidiuretic and vasopressor effects. Oxytocin is more likely to cause hypertension, not decreased blood pressure and a rise in blood sugar levels due to the body's natural stress response. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
5 See full question 13s The nurse is preparing to give a 25-year-old female client an injection of carboprost. What would be most important for the nurse to do?
Assess for contraindications or cautions. Explanation: Abortifacients should not be used with any known allergy to abortifacients or prostaglandins to avoid hypersensitivity reactions, after 20 weeks from the last menstrual period which would be too late into the pregnancy for an abortion, or with active PID or acute cardiovascular, hepatic, renal, or pulmonary disease. Assessing vital signs would be important and so would drawing up the medication and injecting within 5 minutes, but they are not the most important nursing actions. It would be inappropriate to try to talk the mother out of taking the drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
18 See full question 15s The nurse should perform which priority assessment prior to admininistering methylergonovine (Methergine) to a postpartum client? Select the best response.
Blood pressure Explanation: Methylergonovine may cause hypertension, so the nurse must assess the client's blood pressure prior to administering this drug. The drug is not given routinely IV because it may produce sudden hypertension and stroke. If the drug is ordered IV, administer it slowly over a period of 1 minute or more with close monitoring of the patient's blood pressure. The other vital signs are important to assess, however with this medication specifically, the blood pressure is the priority. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
3 See full question 17s What would the nurse assess for before beginning an infusion of pitocin?
Cephalopelvic proportions Explanation: Pitocin is used to stimulate labor and often results in intense uterine contractions. It is important that the appropriate cephalopelvic proportions exist to allow a vaginal delivery and to prevent damage to the fetus and the mother if these intense contractions cannot expel the fetus. Dilation may be well underway when pitocin is started or may need to be initiated. Respiratory excursion are limited in pregnant women because of the enlarge uterus. Electrocardiogram readings should not be needed in normal situations. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
10 See full question 14s The nurse is aware that methylergonovine would be administered with great caution to which clients? Select all that apply.
Client who smokes heavily Client with cardiac disease Client with kidney disease Explanation: Methylergonovine is contraindicated in clients who have hypertension; cardiac disease; vascular disase with narrowed vessels; renal and liver disease; and smoke heavily. It is also contraindicated in clients who are lactating. Excessive vasoconstriction can occur in these clients. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
14 See full question 13s The nurse is caring for a woman receiving oxytocin to increase the strength of her uterine contractions. Because the client reports smoking two packs of cigarettes per day, the nurse will observe her for what complications?
Cold, bluish colored feet Explanation: Women who are heavy smokers are at risk for excessive vasoconstriction when receiving oxytocin. A sign of vasoconstriction would be lack of blood flow to the feet, resulting in cold feet that are blue in color. Swollen hands, diarrhea, and hypotension are not signs of vasoconstriction. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547. Chapter 46: Uterine Drugs - Page 547 Add a Note
7 See full question 19s The client is receiving oxytocin to initiate labor. The nurse must observe for what adverse effects? (Select all that apply.)
Fetal bradycardia Uterine rupture Cardiac arrhythmias Uterine hypertonicity Explanation: The administration of oxytocin may result in the following adverse reactions: feta bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardia arrhythmias, and anaphylactic reactions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
11 See full question 16s The nurse must complete which assessments prior to starting an IV infusion of oxytocin for induction of labor? (Select all that apply.)
Fetal heart rate Client blood pressure Client respiratory rate Explanation: Immediately prior to beginning the IV infusion of oxytocin, the nurse assesses and documents the fetal heart rate and the client's blood pressure, pulse, and respiratory rate. It is not necessary to assess the client's pain rating or the amount of fetal movement prior to starting the infusion. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
1 See full question 35m 3s A client is to receive oxytocin by IV infusion to promote labor. What would be most important to assess before initiating the therapy? (Select all that apply.)
Fetal position Uterine tone Fetal heart rate Maternal blood pressure Explanation: Assessing fetal position is important to ensure that there is no cephalopelvic disproportion to complicate labor. Assessing uterine tone is important because oxytocin can overstimulate the uterus. Assessing fetal heart rate is important to establish fetal well being. Assessing maternal blood pressure would be important because the drug is discontinued if the blood pressure rises dramatically. Assessing uterine involution would be appropriate after delivery. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
17 See full question 11s The nurse is aware that intranasal oxytocin is used for what reason?
Help with milk letdown in breastfeeding Explanation: Intranasal oxytocin is only used to stimulate the milk ejection (milk letdown) reflex to allow for successful breastfeeding. Oxytocin in the intranasal form is not used to cause contraction of the fundus, nor to control bleeding in the postpartum period. Oxytocin is only ever used to stimulate the uterus, not prevent, slow down or decrease the intensity of contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
16 See full question 16s The labor and delivery nurse understands the importance of giving methylergonovine IM and not IV at the time of the delivery of the anterior shoulder. Why should this drug be given IM and not IV?
It may produce sudden hypertension and stroke. Explanation: Methylergonovine is usually given IM at the time of the delivery of the anterior shoulder or after the delivery of the placenta. The drug is not given IV routinely because it may produce sudden hypertension and stroke. If given IV the nurse must give it slowly and closely monitor the blood pressure. The other options do not apply. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545. Chapter 46: Uterine Drugs - Page 545 Add a Note
6 See full question 1m 12s In a client receiving oxytocin therapy, the nurse identifies tachysystole accompanied by a reassuring FHR. Which step should the nurse take to minimize adverse effects to the mother and the baby?
Place the client in a lateral position and monitor closely Explanation: In the event of tachysystole with a reassuring FHR, the nurse should: (1) place the mother in a lateral position, (2) provide an IV fluid bolus of 500 mL lactated Ringers, (3) if uterine activity has not returned to normal after 10 minutes, decrease oxytocin rate by half, and (4) if uterine activity has not returned to normal after 10 minutes more, discontinue oxytocin until normal uterine activity resumes and notify the provider. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547. Chapter 46: Uterine Drugs - Page 547 Add a Note
3 See full question 13s When caring for a client who is receiving a tocolytic for the management of preterm labor, the nurse observes signs of hypotension in the client. Which interventions should the nurse perform to minimize hypotension?
Place the client in the left lateral position. Explanation: When managing a client who is receiving a tocolytic, the nurse continuously monitors the client so that he or she may recognize hypotension. If it occurs, the client is placed in the left lateral position and the primary health care provider is notified because a dosage change may be necessary. The health care provider orders the administration of the medication and adjustments made using blood pressure and pulse parameters. The tocolytic is not stopped abruptly, not is a dose skipped. If the medication needs adjusted due to hypotension, decreasing the tocolytic will increase the blood pressure, so there would be no need to administer an antihypotensive drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 547. Chapter 46: Uterine Drugs - Page 547 Add a Note
17 See full question 22s What are the top priority interventions if the nurse observes hypertonic uterine contractions in a woman receiving oxytocin? Select all that apply.
Provide supplemental oxygen. Stop the oxytocin infusion. Explanation: If hypertonic uterine contractions are noted, the nurse should immediately stop the oxytocin infusion, provide supplemental oxygen, and turn the woman on her left side. Carboprost is not used until after delivery of the placenta. The nurse does not prepare for immediate delivery of the fetus, rather takes steps to make sure that the fetus has handled the hypertonic contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545. Chapter 46: Uterine Drugs - Page 545 Add a Note
16 See full question 9s For which administration route should the nurse prepare to administer misoprostol to a client for induction of labor?
Vaginally Explanation: Misoprostol is administered vaginally to induce or augment uterine contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
8 See full question 16s The health care provider has ordered oxytocin to be administered via IV pump and titrated until a client's contractions are every 3 minutes. The nurse caring for the client is aware that oxytocin can cause dangerous effects to the CNS, musculoskeletal, and cardiovascular systems of the client. What is the cause of these adverse effects?
Water intoxication Explanation: Oxytocin increases the water permeability of the nephron, which causes more water retention than sodium reabsorption and, in turn, leads to water intoxication. Symptoms of water intoxication primarily affect the CNS and musculoskeletal systems. Oxytocin infusions, when given to a client with autism or Asperger's disorder, result in a significant reduction in repetitive behaviors. Tachysystole and abnormal atrioventricular rhythms are not the cause of adverse effects. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
4 See full question 26s A nurse is caring for a client who is receiving magnesium. The nurse would be alert for which finding?
depressed reflexes Explanation: Magnesium affects the neuromuscular system, so the nurse would assess mentation, cranial nerve function, and deep tendon reflexes. Depressed reflexes would be a cause for concern. Vasoconstriction can occur when methylergonovine (Methergine) is administered to a client who is a heavy smoker. The calcium channel blocker (nifedipine) and the beta2-adrenergic drug (terbutaline) are used to delay the delivery process for 24 to 48 hours. Sweating, hypotension, depressed reflexes, and flaccid paralysis are other adverse reactions associated with IV administration. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
4 See full question 46s A nurse is required to care for a client receiving IV oxytocin. Which signs and symptoms would alert the nurse to the development of water intoxication? Select all that apply.
drowsiness confusion rapid breathing Explanation: When oxytocin is administered IV, there is a danger of an excessive fluid volume (water intoxication) because oxytocin has an antidiuretic effect. The nurse should measure the fluid intake and output and look for signs of fluid overload such as drowsiness, confusion, headache, listlessness, wheezing, coughing, and rapid breathing and inform the primary health care provider if any of these are noted. As the fluid output is decreased in this condition, the client will not show signs of increased micturition. Pain is normally involved with any kind of parenteral therapy and is not a characteristic sign to distinguish water intoxication. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
20 See full question 25s A client is receiving tocolytic therapy to halt preterm labor. While assessing the client, the nurse suspects that the client may be developing pulmonary edema based on assessment of which finding? Select all that apply.
dyspnea tachypnea frothy sputum Explanation: Signs of pulmonary edema include dyspnea, tachycardia, increased respiratory rate (tachypnea), crackles, and frothy sputum. Cough and clear breath sounds are not associated with pulmonary edema.
20 See full question 7s A client is prescribed carboprost as treatment for postpartum hemorrhage. The nurse would administer this drug by which route?
intramuscular Explanation: Carboprost is administered by IM injection. It is not given IV, subcutaneously, or orally.
8 See full question 22s The nurse knows that which of the following is not administered until after the placenta is delivered? (Select all that apply.)
misoprostol methylergonovine Explanation: Misoprostol and methylergonovine are not used before the delivery of the placenta. Indocin, nifedipine and magnesium both are tocolytics and ususally are administered during preterm labor. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
3 See full question 39s A client with preeclampsia has been prescribed magnesium sulfate for seizure prevention. The nurse understands that the effectiveness of which drugs is increased by concomitant use of magnesium sulfate? Select all that apply.
opioids sedatives analgesics Explanation: There is an increased effectiveness of CNS depressants such as opioids, analgesics, and sedatives when coadministered with magnesium sulfate. The effectiveness of neuromuscular blocking agents is enhanced as well. However, the addition of magnesium sulfate leads to the lowering of blood levels of tetracycline. Magnesium sulfate interferes with the absorption of digoxin, potentially reducing its efficacy. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
11 See full question 22s A client receiving magnesium for preterm labor is demonstrating signs of an adverse reaction. What are symptoms of the adverse reactions related to hypocalcemia induced by the therapy? (Select all that apply.)
sweating hypotension depressed reflexes flaccid paralysis Explanation: Adverse reactions to magnesium related to hypocalcemia induced by the therapy are sweating, hypotension, depressed reflexes, and flaccid paralysis. Uterine stimulants such as oxytocin are most likely to cause temporary chest pain as an adverse reaction to the medication. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
7 See full question 5m 23s A client is started on terbutaline therapy. What would indicate that the therapy has been successful?
Premature birth is avoided for at least 24 hours. Explanation: Terbutaline drug therapy is considered effective when all the following have been achieved: the premature contractions decrease in intensity and frequency; the woman and fetus do not experience adverse effects; and premature birth is avoided for at least 24 hours so that administered corticosteroids can exert their beneficial effects. Terbutaline is not to be given for labor induction but to stop preterm labor. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 546. Chapter 46: Uterine Drugs - Page 546 Add a Note
12 See full question 19s Which is the term for the adverse reaction (fluid volume excess) that occurs sometimes when oxytocin is administered continuously IV while the client is also receiving fluids by mouth?
Water intoxication Explanation: Because of its antidiuretic effect, serious water intoxication (fluid overload, fluid volume excess) may occur, particularly when the drug is administered by continuous infusion and the client is receiving fluids by mouth. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 545. Chapter 46: Uterine Drugs - Page 545 Add a Note
19 See full question 18s The nurse is aware that when using oxytocin for labor induction, oxytocin is similar to what other hormone?
Vasopressin Explanation: Oxytocin is similar to the hormone vasopressin and has an antidiuretic effect. It is not similar to insulin, thyroid stimulating hormone, or parathyroid hormone. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
2 See full question 19s The nurse would be alert for signs and symptoms of which if methylergonovine is prescribed for a client who is a heavy smoker?
vasoconstriction Explanation: Vasoconstriction can occur when methylergonovine is administered to a client who is a heavy smoker not vasodilation. Diuresis is the effect of the use of diuretic medications used as in the condition of congestive heart failure. Electrolyte imbalance can occur with the use of diuretics as water is eliminated, electrolytes are also eliminated unless potassium-sparing diuretics are used. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
2 See full question 16s The use of ergonovine and methylergonovine can result in ergotism, which is characterized by which symptom?
Chest pain Explanation: The use of ergonovine and methylergonovine can result in ergotism, which is characterized by coolness, numbness and tingling of extremities, dyspnea, nausea, confusion, tachycardia or bradycardia, chest pain, hallucinations, and convulsions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
2 See full question 7s A nurse should monitor a client receiving oxytocin for which adverse effects?
cardiac arrhythmias Explanation: A nurse should monitor a client receiving oxytocin for the following adverse effects: fetal bradycardia, uterine rupture, uterine hypertonicity, nausea, vomiting, cardiac arrhythmias, and anaphylactic reactions. Hypotension, headache, and dizziness are not adverse reactions of oxytocin. Hypotension can be seen with uterine rupture due to hypovolemia, along with dizziness due to low blood pressure. Headache can be seen with the use of hormone medications such as birth control. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
1 See full question 18s A client with postpartum bleeding has been prescribed 0.6 mg of methyl-ergonovine IM. The available drug is in the form of a 0.2 mg/mL. To meet the recommended dose, what volume of the solution should the nurse administer to the client?
3 mL Explanation: The required dosage of methyl-ergonovine is 0.6 mg. The available ampoules contain 0.2 mg/mL of the drug. Therefore, 3 mL (0.6/0.2) solution needs to be administered in each dose. The nurse needs to administer the correct dosage of the drug to exert its full therapeutic effect. An increased dosage might lead to complications. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
15 See full question 21s Which assessment findings indicate a woman having her labor induced with IV oxytocin is developing water intoxication? (Select all that apply.)
Headache Confusion Coughing Explanation: Signs of water intoxication include drowsiness, confusion, headache, listlessness, wheezing, coughing, or rapid breathing. Anxiety and low respiratory rate are not signs of water intoxication. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
1 See full question 5m 33s Which is an adverse effect caused by all uterine stimulants because of their antidiuretic effect?
water intoxication Explanation: Water intoxication is an adverse effect caused by all uterine stimulants because of their antidiuretic effect. Dehydration occurs when the body does not have enough fluid to sustain homeostasis. Hypotension can result in pregnancy with uterine rupture and loss of circulating blood volume. Polydipsia is seen in diabetes as well as pregnancy-induced diabetes. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
1 See full question 12s A client is prescribed oxytocin to stimulate the milk ejection reflex. The nurse would expect this drug to be administered by which route?
intranasally Explanation: The nurse should administer oxytocin intranasally to a client to stimulate the milk ejection reflex. Oxytocin can be given intramuscularly (IM) during the third stage of labor (period from the time the baby is born until the placenta is expelled) to produce uterine contractions and control postpartum bleeding and lessen hemorrhage potential. The other uterine stimulants may be given orally, rectally, or IM during the postpartum period to reduce the possibility of postpartum hemorrhage and to prevent relaxation of the uterus. Oxytocin is not given topically. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 543. Chapter 46: Uterine Drugs - Page 543 Add a Note
5 See full question 20s A nurse is caring for a client who is at 28 weeks' gestation and is receiving terbutaline (Brethine) to control preterm labor. Which assessment parameters should the nurse prioritize?
Fetal heart rate (FHR) Explanation: When a client is taking terbutaline, the nurse should closely monitor the maternal heart rate, the FHR, and the maternal blood pressure and fluid status. The fetal position may be determined to assess the chances of successful delivery and the need to induce labor, but is not related to taking terbutaline. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
15 See full question 33s The nurse will monitor a woman receiving oxytocin for what abnormal finding in the fetal assessment?
Fetal heart rate of 84 bpm Explanation: Though oxytocin does not cause many fetal problems, fetal bradycardia can occur, which is one of the reasons that electronic fetal monitoring is required if a woman receives oxytocin. Oxytocin has not been known to cause fetal tachycardia, or problems with fetal movement. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
6 See full question 22s For which conditions can oxytocin be used? (Select all that apply.)
IV for starting labor IV for improving labor IV for managing abortions IM used in third-stage labor to control bleeding Intranasally to stimulate milk ejection Explanation: Oxytocin is given IV to start or improve labor. It also can be given to manage inevitable or incomplete abortions, and given IM in third-stage labor to control uterine bleeding. It can be given intranasally to stimulate the milk ejection (milk letdown) reflex. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
9 See full question 27s When monitoring a client receiving IV oxytocin, the nurse should stop the infusion immediately and call the health care provider when what occurs? (Select all that apply.)
Significant change in FHR or rhythm Marked change in frequency, rate, or rhythm of contractions Contractions lasting longer than 60 seconds Marked increase in client's blood pressure Contractions more frequent than every 2 to 3 minutes Explanation: When monitoring uterine contractions, whether the client is on IV oxytocin or not, the nurse notifies the provider immediately if any of the following occurs: significant change in fetal heart rate or rhythm; a marked change in the frequency, rate, or rhythm of contractions; contractions that last longer than 60 seconds or occur more frequently than every 2 to 3 minutes; no palpable relaxation of the uterus; a marked increase or decrease in the client's blood pressure or pulse; or any change in the client's general condition. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 544. Chapter 46: Uterine Drugs - Page 544 Add a Note
19 See full question 16s A group of nursing students are reviewing information about oxytocin for labor induction. The students demonstrate understanding of this drug, identifying which as the maximum dose for induction?
10 units/min Explanation: When used for labor induction, the dose is individualized but does not exceed 10 units/min. More than 10 units/min can lead to uterine rupture. Oxytocin can be given at 10 units/min as prescribed by the health care provider and adjusted to enhance labor contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
6 See full question 41m 36s A nurse administers methylergonovine (Methergine) to a client immediately after delivery of a normal, healthy baby boy. The nurse will advise her that she may experience which common adverse effect of the drug?
An increase in blood pressure Explanation: Methylergonovine is given orally three or four times a day beginning immediately postpartum for a maximum of 1 week. Hypertension, sometimes with seizures or headache, is the most common adverse effect. Tingling of the extremities and numbness are signs of acute overdose. Diarrhea is not associated with the use of the drug. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 548. Chapter 46: Uterine Drugs - Page 548 Add a Note
13 See full question 17s A client who has come to the prenatal clinic for an assessment has begun to have contractions. The client is presently at 29 weeks of pregnancy. The nurse anticipates which medication will be prescribed to stop the preterm labor?
indocin Explanation: Indocin is used for preterm labor before 31 weeks' gestation. It can be given rectally and then orally for a total of 8 doses. Carboprost, misoprostol and oyxtocin are used to induce, not prevent, uterine contractions. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 549. Chapter 46: Uterine Drugs - Page 549 Add a Note
14 See full question 1m 2s A client giving birth to twins begins to have contractions. The client's health care provider tells her to go to the emergency department (ED) for examination. The client is only 34 weeks' gestation. The nurse expects the health care provider to order:
magnesium. Explanation: The health care provider will more than likely order magnesium to stop the labor. The other drugs listed are oxytocics, which are used to initiate labor or control postpartum bleeding, uterine atony, or hemorrhage. Reference: Ford, Susan M., Roach's Introductory Clinical Pharmacology, 11th ed., Philadelphia, Wolters Kluwer, 2018, Chapter 46: Uterine Drugs, p. 549. Chapter 46: Uterine Drugs - Page 549 Add a Note
