NCLEX - Drugs Used in Obstetrics

A patient is a gravida 1, Rh-negative woman at a 28 weeks gestation. The father of her child is Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM that has been ordered. What is the nurses best reply? a. Your child will do well after birth once transfusions are administered. b. If the baby is Rh negative at birth, he or she will need RhoGAM also. c. RhoGAM kills antibodies you make, so your child will be protected. d. Your baby may be Rh positive and cause you to make antibodies. These wont affect this baby, but could affect future children if RhoGAM isnt given.

ANS: D - An Rh-negative mother and an Rh-positive father have the potential for an Rh-positive baby. At birth or during any time that the uterus ruptures, fetal blood circulation can mix with maternal circulation, causing the mother to produce antibodies (active immunity) against Rh-positive blood. This would cause Rh hemolytic disease in children of future pregnancies. Rho(D) immune globulin suppresses the stimulation of active immunity by Rh-positive foreign red blood cells that enter maternal circulation at the time of delivery, at the termination of pregnancy, or during a transfusion of inadequately typed blood. Transfusions may cause further problems. Immune globulin is given to the mother. The drug does not kill antibodies; it suppresses production.

A woman is 32 weeks pregnant and has been examined by the health care provider on June 1. She is scheduling her next appointment. The most appropriate day for the nurse to schedule the appointment is: a. June 9 b. June 16 c. June 30 d. July 7

ANS: B - The pregnant woman who does not experience complications is usually examined monthly for the first 6 months, every 2 weeks in the seventh and eighth months, and weekly during the last month.

Which is characterized by seizures? a. Pregnancy induced hypertension b. Preeclampsia c. Eclampsia d. Premature rupture of membranes

ANS: C - Eclampsia (convulsions accompanying preeclampsia) is characterized by seizures. Pregnancy induced hypertension is characterized by sudden hypertension (an elevation of systolic pressure 30 mm Hg or more than prior readings, systolic blood pressure of 140 mm Hg or more, or diastolic pressure of 90 mm Hg or more). Preeclampsia is characterized by elevated blood pressure and proteinuria. Premature rupture of membranes is characterized by leakage of amniotic fluid from the vagina.

The nurse administers hydralazine IV to control the blood pressure of a woman diagnosed with preeclampsia. If the nurse administered this medication at 0800, the next assessment of blood pressure should occur at: a. 0803 b. 0815 c. 0830 d. 1000

ANS: A - The vasodilator hydralazine is usually administered to control blood pressure. If IV has been given, monitor the maternal and fetal heart rates and the mothers blood pressure every 2 to 3 minutes after the initial dose and every 10 to 15 minutes thereafter.

Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after the placenta has been delivered? a. Oxytocin (Pitocin) b. Magnesium sulfate c. Vitamin K d. Dopamine

ANS: A - Uterine stimulants, primarily oxytocin, given in low dose infusions after delivery of the fetus and placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin K is given to prevent hemorrhage. Dopamine is given to treat hypotension.

Which assessment(s) will the nurse complete during routine pregnancy visits? (Select all that apply.) a. Blood pressure b. Hemoglobin c. Weight d. Fetal heart sounds e. Glucose tolerance test (GTT)

ANS: A, C, D - Assessments during routine pregnancy visits include blood pressure, weight, and fetal heart sounds. Assessments during routine pregnancy visits do not include hemoglobin or GTT.

Which test would the nurse anticipate to be done to determine if preterm labor is present in a patient whose symptoms are questionable? a. Sonogram b. Fetal fibronectin test c. Amniocentesis d. Doppler study

ANS: B - A fetal fibronectin test may be ordered to assess the presence of preterm labor in patients whose presenting symptoms are questionable, so that early intervention (e.g., tocolytic therapy, corticosteroids, transport to a tertiary center) can be initiated when indicated. Sonograms determine the presence and viability of a fetus. Amniocentesis determines genetic problems in a fetus. Doppler determines circulation in the vascular system of the mother or the baby.

When caring for the neonate immediately following delivery, the priority nursing diagnosis will be: a. risk for bleeding. b. altered body temperature. c. ineffective airway clearance. d. risk for infection.

ANS: C - Ensuring that the airway remains open is the priority because if the airway does not remain patent, oxygenation will be impaired. Risk for bleeding, altered body temperature, and risk for infection are relevant but not priorities at this time.

Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn? a. Silver nitrate b. Dexamethasone c. Erythromycin d. Vitamin K

ANS: C - Erythromycin or tetracyclines are the drugs of choice because they prevent neonatal conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum from Chlamydia trachomatis. Silver nitrate is an outdated treatment for neonatal ocular infections. Dexamethasone is given for lung development. Vitamin K is given for treatment of hemorrhage.

Which emergency drug must be available when caring for a patient receiving magnesium sulfate? a. Naloxone b. Calcium gluconate c. Dextrose d. Dopamine

ANS: B - Calcium gluconate is the antidote for magnesium sulfate and should always be available when magnesium sulfate is administered. Naloxone is an antidote for opioid drugs. Dextrose is given to treat hypoglycemia. Dopamine is given to treat hypotension.

Which medication is used to treat a patient with atonic uterus? a. Estradiol b. Ergonovine c. Ergotamine d. Egophony

ANS: B - Continued intravenous infusions of low dose oxytocin or intramuscular injections of ergonovine or methylergonovine may be used to stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage from an atonic uterus. Estradiol is an estrogen and is not used to treat atonic uterus. Ergotamine is used to treat migraine headaches. Egophony is a change in lung sounds characteristic of pleural effusion.

A patient at 33 weeks gestation is admitted to the obstetric unit in active labor with symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse implement? (Select all that apply.) a. Vital signs hourly b. Administration of IV pitocin c. Administration of magnesium sulfate IV d. Fetal stress test e. Assessment of deep tendon reflexes

ANS: A, C, D, E - Important nursing assessments and/or interventions include monitoring of vital signs and level of consciousness continuously, continuous fetal monitoring with stress tests and external or internal fetal monitoring, and deep tendon reflexes. IV magnesium sulfate is often prescribed for patients with PIH. Oxytocin increases uterine contractions and is contraindicated in preterm labor.

Which drug will the health care provider prescribe to soften the cervix of a woman who is at 42 weeks of gestation? a. Methylergonovine (Methergine) b. Dinoprostone (Prepidil) c. Betamethasone (Celestone) d. Terbutaline (Brethine)

ANS: B - Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle stimulation. It is used to start and continue cervical ripening at term. Methergine is used to treat postpartum bleeding. Betamethasone is used to enhance fetal lung development. Terbutaline is used to treat premature labor.

For which reason will betamethasone IM be administered to the mother in premature labor? a. To stop uterine contractions b. To prevent precipitous labor c. To stimulate lung maturity in the fetus d. To stimulate prolactin to enhance breastfeeding

ANS: C - Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize respiratory distress syndrome. Tocolytic drugs are given to stop uterine contractions. Prolactin production and release are triggered by pituitary hormone, estrogen, and progesterone.

A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120 mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health care provider will order? a. Nifedipine (Procardia) b. Furosemide (Lasix) c. Magnesium sulfate d. Terbutaline (Brethine)

ANS: C - Magnesium sulfate depresses the central nervous system and blocks peripheral nerve transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Hypertension, headache, and edema are signs of preeclampsia in a pregnant woman. Calcium channel blockers, such as nifedipine, are sometimes given as tocolytic agents. Furosemide is given for diuresis; it may be used in the treatment of hypertension, but not eclampsia. Terbutaline is given as a tocolytic agent.

What will the nurse include when teaching a postpartum patient about expected adverse effects of Rho(D) immune globulin? (Select all that apply.) a. Nausea b. Constipation c. Fever d. Insomnia e. Aches f. Diarrhea g. Anorexia

ANS: C, E - Fever as well as generalized aches and pains are common adverse effects of treatment with this drug. Nausea, constipation, insomnia, diarrhea, and anorexia are not adverse effects of Rho(D) immune globulin.

Which drug is administered when a patient is experiencing premature labor? a. Magnesium sulfate b. Oxytocin (Pitocin) c. Levonorgestrel (Mirena) d. Terbutaline (Brethine)

ANS: D - Terbutaline is a beta adrenergic receptor stimulant, which acts primarily on the beta2 receptors. Stimulation of beta1 receptors produces uterine relaxation and relaxation of the bronchial and vascular smooth muscle. In higher doses, terbutaline will stimulate the beta1receptors, which raises heart rate. Magnesium sulfate is given to treat eclampsia. Oxytocin is given to produce uterine contractions. Levonorgestrel is a progestin given for contraception.

A 26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400 assessment includes: BP - 100/70 mm Hg Respiration - 10 Fetal heart tone - 100/min Urine output - 20 mL/hr Absent patellar reflex Which is the priority nursing action? a. Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15 minutes. b. Stop the IV magnesium sulfate and contact the health care provider. c. Place the patient on her left side and administer oxygen. d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

ANS: D - The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression. The infusion should be stopped at once. The antidote, calcium gluconate, should be administered.