14. Maternal & Newborn Medications
Rho(D) immune globulin: who, how, when
-administered to Rh-negative pts (to suppress antibody formation) -administered IM -administered at 28 weeks' gestation and within 72 hrs after delivery -administered 72 hrs postpartum to all Rh-negative mothers who have Rh-positive newborns
medications for preterm labor (3)
-magnesium sulfate (tocolytic) -nifedipine (calcium channel blocker, tocolytic) -betamethasone (fetal lung development)
epidural/spinal block adverse effects (4)
-maternal hypotension -fetal bradycardia -inability to feel urge to void -loss of bearing down reflex
tocolytics: MOA, indication
-medications that produce uterine relaxation and suppress uterine activity -used to halt contractions and prevent preterm birth
rubella vaccine: who, how, when
-pt who has rubella titer <1:8 -administered subcutaneous injection -administered postpartum
An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1. Naloxone 2. Morphine sulfate 3. Betamethasone 4. Meperidine hydrochloride
1. Naloxone NCLEX
The labor room nurse assists with the administration of a lumbar epidural block. How should the nurse check for the major side effect associated with this type of regional anesthesia? 1. Assessing the mother's reflexes 2. Taking the mother's temperature 3. Taking the mother's apical pulse 4. Monitoring the mother's blood pressure
4. Monitoring the mother's blood pressure NCLEX
Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts the health care provider who prescribed the medication if which condition is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease
4. Peripheral vascular disease NCLEX
carboprost: drug class, indication
prostaglandin -postpartum hemorrhage
prostaglandins: MOA
-ripen the cervix, making it softer and causing it to begin to dilate and efface -stimulate uterine contractions
oxytocics: MOA, indications (2)
-stimulates uterine muscle and increases force, frequency, and duration of contractions -labor induction or augmentation -control postpartum bleeding
The nursing instructor asks a nursing student to describe the procedure for administering erythromycin ointment to the eyes of a newborn. Which student statement indicates that further teaching is needed? 1. "I will flush the eyes after instilling the ointment." 2. "I will clean the newborn's eyes before instilling ointment." 3. "I need to administer the eye ointment within 1 hr after delivery." 4. "I will instill the eye ointment into each of the newborn's conjunctival sacs."
1. "I will flush the eyes after instilling the ointment." NCLEX
Butorphanol tartrate is prescribed for a woman in labor, and the woman asks the nurse about the purpose of the medication. The nurse should make which most appropriate response? 1. "The medication provides pain relief during labor." 2. "The medication will help prevent any nausea and vomiting." 3. "The medication will assist in increasing the contractions." 4. "The medication prevents respiratory depression in the newborn infant."
1. "The medication provides pain relief during labor." NCLEX
A client diagnosed with severe preeclampsia is receiving magnesium sulfate by continuous intravenous infusion. Which assessment finding would indicate that the medication should be discontinued? 1. Absence of deep tendon reflexes 2. Respiratory rate of 16 breaths per minute 3. Urinary output of 45 mL during the past hour 4. Decrease in blood pressure from 180/100 mm Hg to 150/90 mm Hg
1. Absence of deep tendon reflexes (everything else is WNL) NCLEX
carboprost adverse effects (6)
-hypertension -fever -chills -headache -nausea, vomiting -diarrhea
nursing interventions to manage maternal hypotension (4)
-IV fluid bolus (offset hypotension) -position mother laterally/side-lying (keep fetus off vena cava) -raise bed side rails (orthostatic hypotension) -assess for bladder distention
betamethasone administration
-administered IM -2 injections 24 hrs apart -administered 24 and 48 hrs prior to birth -requires 24 hr to be effective
Which medication should the nurse plan to administer to a newborn by the intramuscular (IM) route? 1. Erythromycin 2. Tetracycline 3. Phytonadione (Vitamin K) 4. Measles-mumps-rubella vaccination
3. Phytonadione (Vitamin K) NCLEX
betamethasone adverse effects (2)
-pulmonary edema (chest pain, SOB, lung crackles) -hyperglycemia
magnesium sulfate toxicity symptoms (5)
-respiratory depression (<12 breaths/min) -↓ DTRs -hypotension -↓ urine output <30 mL/hr -pulmonary edema (chest pain, SOB, lung crackles)
nifedipine: drug class, indication
calcium channel blocker, tocolytic -prevent preterm labor
varicella vaccine: who, when
-if mother has no immunity, varicella vaccine is administered before discharge -2nd dose is given at 4-8 weeks (ATI p 122)
medications for postpartum hemorrhage (4)
-oxytocin -methylergonovine -misoprostol -carboprost
A client in labor is receiving oxytocin by intravenous infusion to stimulate uterine contractions. Which finding indicates that the rate of the infusion needs to be decreased? 1. Increased urinary output 2. A fetal heart rate of 180 beats/min 3. Three contractions occurring in a 10-minute period 4. Adequate resting tone of the uterus palpated between contractions
2. A fetal heart rate of 180 beats/min (acute hypoxia is common cause of fetal tachycardia - oxytocin should be decreased in the presence of fetal tachycardia) NCLEX
A nurse is preparing to administer a vitamin K (phytonadione) injection to a newborn. Which of the following responses should the nurse make to the newborn's mother regarding why this medication is given? A. "It assists with blood clotting." B. "It promotes maturation of the bowel." C."It is a preventative vaccine." D. "It provides immunity."
A. "It assists with blood clotting." ATI
A nurse is providing care for a client who is at 32 weeks of gestation and who has a placenta previa. The nurse notes that the client is actively bleeding. Which of the following types of medications should the nurse anticipate the provider will prescribe? A. Betamethasone B. Indomethacin C. Nifedipine D. Methylergonovine
A. Betamethasone (to promote lung maturity if delivery is anticipated) ATI
A nurse is caring for a client who has a prescription for magnesium sulfate. The nurse should recognize that which of the following are contraindications for use of this medication? (Select all that apply) A. Fetal distress B. Preterm labor C. Vaginal bleeding D. Cervical dilation greater than 6cm E. Severe gestational hypertension
A. Fetal distress C. Vaginal bleeding D. Cervical dilation greater than 6cm ATI
A nurse is caring for a client who is in the second stage of labor. The client's labor has been progressing, and she is expected to deliver vaginally in 20 min. The provider is preparing to administer lidocaine for pain relief and perform an episiotomy. The nurse should know that which of the following types of regional anesthetic blocks is to be administered? A. Pudendal B. Epidural C. Spinal D. Paracervical
A. Pudendal (transvaginal injection of local anesthetic that anesthetizes the perineal area for episiotomy and repair and expulsion of the fetus) ATI
A nurse is administering magnesium sulfate IV to a client who has severe preeclampsia for seizure prophylaxis. Which of the following indicates magnesium sulfate toxicity? (Select all that apply) A. Respirations less than 12/min B. Urinary output less than 30 mL/hr C. Hyperreflexic deep-tendon reflexes D. Decreased LOC E. Flushing and sweating
A. Respirations less than 12/min B. Urinary output less than 30 mL/hr D. Decreased LOC ATI
A nurse is caring for a client who is receiving nifedipine for prevention of preterm labor. The nurse should monitor the client for which of the following manifestations? A. Blood-tinged sputum B. Dizziness C. Pallor D. Somnolence
B. Dizziness (calcium channel blocker = orthostatic hypotension) ATI
A nurse is reviewing a new prescription for ferrous sulfate with a client who is at 12 weeks of gestation. Which of the following statements by the client indicates understanding of the teaching? A. "I will take this pill with my breakfast." B. "I will take this medication with a glass of milk." C. "I plan to drink more orange juice while taking this pill." D. "I plan to add more calcium-rich foods to my diet while taking this medication."
C. "I plan to drink more orange juice while taking this pill." ATI
A nurse is caring for a client following the administration of an epidural block and is preparing to administer an IV fluid bolus. The client's partner asks about the purpose of the IV fluids. Which of the following is an appropriate response for the nurse to make? A. "It is needed to promote increased urine output." B. "It is needed to counteract respiratory depression." C. "It is needed to counteract hypotension." D. "It is needed to prevent oligohydramnios."
C. "It is needed to counteract hypotension." ATI
A nurse is preparing to administer prophylactic eye ointment to a newborn to prevent ophthalmia neonatorum. Which of the following medications should the nurse anticipate administering? A. Ofloxacin B. Nystatin C. Erythromycin D. Ceftriaxone
C. Erythromycin ATI
Prostaglandin gel is ordered to be administered vaginally. Which of the following would indicate that there has been a therapeutic response to this medication? A. Resting periods between contractions B. FHR beats and patterns within normal limits C. Softening of the cervix and beginning effacement D. Leaking of a small amount of clear amniotic fluid
C. Softening of the cervix and beginning effacement disc
A nurse is caring for a client who is receiving IV magnesium sulfate. Which of the following medications should the nurse anticipate administering if magnesium sulfate toxicity is suspected? A. Nifedipine B. Pyridoxine C. Ferrous sulfate D. Calcium gluconate
D. Calcium gluconate ATI
A nurse is caring for the mother of a newborn. The mother asks the nurse when her newborn should receive his first diphtheria, tetanus, and pertussis vaccine (DTaP). The nurse should instruct the mother that her newborn should receive the immunization at which of the following ages? a. birth b. 2 months c. 6 months d. 15 months
b. 2 months ATI
The nurse is caring for a laboring client who is scheduled for an epidural block. What action by the nurse prior to the epidural placement would decrease the chance of maternal hypotension? a. Monitor maternal vital signs. b. Administer oxygen at 5 L/min. c. Reposition the client every hour. d. Infuse an IV bolus of 500-1000 mL of normal saline.
d. Infuse an IV bolus of 500-1000 mL of normal saline. text
A nurse is caring for a client who has a soft uterus and increased lochial flow. Which of the following medications should the nurse plan to administer to promote uterine contractions? a. Terbutaline b. Nifedipine c. Magnesium sulfate d. Methylergonovine
d. Methylergonovine ATI
A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the following situations should the nurse administer Rh(D) Globulin? a. while the client is in labor b. following an episode of influenza during pregnancy c. prior to a blood transfusion d. at 28 weeks of gestation
d. at 28 weeks of gestation ATI
The nurse is preparing to care for a client in labor. The health care provider has prescribed an IV infusion of oxytocin. The nurse ensures that which intervention is implemented before initiating the infusion? 1. An IV infusion of antibiotics 2. Placing the client on complete bed rest 3. Continuous electronic fetal monitoring 4. Placing a code cart at the client's bedside
3. Continuous electronic fetal monitoring NCLEX
The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment finding would cause the nurse to immediately discontinue the oxytocin infusion? 1. Uterine atony 2. Severe drowsiness 3. Uterine hyperstimulation 4. Early decelerations of the fetal heart rate
3. Uterine hyperstimulation NCLEX
The nurse is monitoring a client who is receiving oxytocin to induce labor. Which assessment findings should cause the nurse to immediately discontinue the oxytocin infusion? (Select all that apply) 1. Fatigue 2. Drowsiness 3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate 5. Early decelerations of the fetal heart rate
3. Uterine hyperstimulation 4. Late decelerations of the fetal heart rate NCLEX
The nurse has a routine prescription to instill erythromycin ointment into the eyes of a newborn. Which statement, if made by the mother, demonstrates understanding of why this medication is used? 1. "The medication will make my baby's eyes sterile." 2. "The medication will help my baby to see more clearly." 3. "The medication will guard my baby's eyes from any infection that occurred during pregnancy." 4. "The medication will help protect my baby's eyes from certain infections transmitted during the labor and delivery process."
4. "The medication will help protect my baby's eyes from certain infections transmitted during the labor and delivery process." NCLEX
A pregnant client seen in the prenatal clinic tells the nurse that the iron supplement started 1 week ago is causing nausea, constipation, and heartburn and that she would like to stop taking the medication. The nurse responds by making which statement to the client? 1. "The fetus needs the iron." 2. "You need to stop the medication immediately." 3. "You need to see the health care provider immediately." 4. "These reactions are most prominent during initial therapy and lessen with continued use."
4. "These reactions are most prominent during initial therapy and lessen with continued use." NCLEX
A client experiencing preterm labor at the 29th week of gestation has been admitted to the hospital. The client has a prescription to receive betamethasone but delivers too quickly for medication administration. As a result of not receiving this medication, which condition is most likely to develop in the preterm newborn? 1. Chlamydia 2. Hypoglycemia 3. Hyperbilirubinemia 4. Respiratory depression
4. Respiratory depression NCLEX
The nurse performs an assessment of a pregnant woman who is receiving intravenous magnesium sulfate for management of preeclampsia and notes that the woman's deep tendon reflexes are absent. On the basis of this finding, the nurse should make which interpretation? 1. The magnesium sulfate is effective. 2. The infusion rate needs to be increased. 3. The woman is experiencing cerebral edema. 4. The woman is experiencing magnesium excess.
4. The woman is experiencing magnesium excess. NCLEX
methylergonovine: drug class, indication
ergot alkaloid -postpartum hemorrhage -NCLEX p 397 -ATI OB p 136 -ATI pharm p 253 -text p 714
betamethasone: drug class, MOA
glucocorticoid -enhances fetal lung maturity -increases production of surfactant
methylergonovine contraindication
hypertension
A nurse is caring for a laboring client who just received an epidural block. What is the major adverse effect for which the nurse should observe? a. Hypotension b. Unilateral block c. Hypertension d. Pruritus
a. Hypotension text
A client whose blood type is A negative declines RhoGAM, stating "I don't believe in vaccinations." The blood type of the father of the baby is unknown. What is the nurse's best response? a. "That's fine as long as you've done your research on it." b. "Declining this is can create very serious problems in future pregnancies." c. "You have to have RhoGAM if your blood is Rh negative." d. "Consider how irresponsible it is to put your children at risk."
b. "Declining this is can create very serious problems in future pregnancies." text
A nurse is completing postpartum discharge teaching to a client who had no immunity to varicella and was given varicella vaccine. Which of the following statements by the client indicates understanding of the teaching? a. "I will need to use contraception for 3 months before considering pregnancy." b. "I need a second vaccination at my postpartum visit." c."I was given the vaccine because my baby is O-positive." d."I will be tested in 3 months to see if i have developed immunity."
b. "I need a second vaccination at my postpartum visit." ATI
A nurse is caring for a client who is receiving oxytocin for induction of labor and has an intrauterine pressure catheter (IUPC) placed to monitor uterine contractions. For which of the following contraction patterns should the nurse discontinue the infusion of oxytocin? a. Frequency of every 2 min b. Duration of 90 to 120 seconds c. Intensity of 60 to 90 mm hg d. Resting tone of 15 mm hg
b. Duration of 90 to 120 seconds (oxytocin is discontinued if uterine hyperstimulation occurs with contration duration >90 sec) ATI
The nurse is caring for primigravida who has expressed a desire for an epidural in her birth plan. What notation in the medical record may require changes to her plan? a. Gestational hypertension b. Platelet count of 90,000 per microliter c. History of cervical biopsy d. Allergy to shellfish
b. Platelet count of 90,000 per microliter (thrombocytopenia is a contraindication to epidural) text
A nurse is caring for a client who received a spinal block for a cesarean birth. The client asks the nurse when she can get out of bed. The nurse's best response is: "You will need to remain in bed for at least _____." a. 1-2 hours b. 24 hours c. 6-12 hours d. 3-4 hours
c. 6-12 hours text
Butorphanol tartrate (Stadol) has been ordered for pain for a laboring client. What part of the medical record should the nurse review prior to administering the medication? a. Surgical history b. Labor course in prior pregnancies c. Allergies d. Psychiatric history
c. Allergies text
A nurse is caring for client who had no prenatal care, is Rh- negative, and will undergo an external version at 37 weeks of gestation. Which of the following medication should the nurse plan to administer prior to the version? a. Prostaglandin gel b. Magnesium sulfate c. Rho(D) immune globulin d. Oxytocin
c. Rho(D) immune globulin (usually administered at 28 weeks) ATI
A nurse is caring for a client who is in labor and has an epidural for pain relief. Which of the following is a complication from the epidural block? a. nausea and vomiting b. tachycardia c. hypotension d. respiratory depression
c. hypotension ATI
magnesium sulfate antidote
calcium gluconate
Immediately after a cesarean section birth, the anesthesiologist plans to inject a narcotic into the epidural space to provide analgesia for approximately 24 hours. Which opioid should the nurse anticipate that the physician would use? a. Naloxone (Narcan) b. Nalbuphine hydrochloride (Nubain) c. Butorphanol tartrate (Stadol) d. Duramorph
d. Duramorph text
A nurse is caring for a laboring client who just received systemic medication for labor pain. Which fetal heart rate pattern would require further action by the nurse? a. Increased fetal heart rate (FHR) variability and early decelerations b. Moderate variability is present. c. Occasional variable decelerations d. Minimal FHR variability and late decelerations
d. Minimal FHR variability and late decelerations text
A nurse is planning care for a client who has a prescription for oxytocin. Which of the following is a contraindication for the use of this medication? a. prolonged rupture of membranes at 38 weeks gestation b. intrauterine growth restriction c. postterm pregnancy d. active genital herpes
d. active genital herpes (active herpes = c-section) ATI
pt teaching: varicella vaccine
don't get pregnant for 1 month following immunization
pt teaching: rubella vaccine
don't get pregnant for 3 months following immunization
The nurse is administering magnesium sulfate to a client for preeclampsia at 34 weeks gestation. What is the priority nursing action for this client? 1. Assess for signs and symptoms of labor. 2. Assess the client's temperature every 2 hours. 3. Schedule a daily ultrasound to assess fetal movement. 4. Schedule a non-stress test every 4 hours to assess fetal well-being.
1. Assess for signs and symptoms of labor. (as a result of the sedative effect of the Mg sulfate, pt may not perceive labor) NCLEX
The nurse gave an intramuscular dose of methylergonovine to a client following delivery of an infant. The nurse determines that this medication had the intended effect if which finding is noted? 1. Decreased pulse rate 2. Increased urine output 3. Improved uterine tone 4. Increased blood pressure
3. Improved uterine tone (acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions; BP may increase, but this is not the intended therapeutic effect) NCLEX
The nurse is monitoring a client in preterm labor who is receiving intravenous magnesium sulfate. The nurse should monitor for which adverse effects of this medication? (Select all that apply) 1. Flushing 2. Hypertension 3. Increased urine output 4. Depressed respirations 5. Extreme muscle weakness 6. Hyperactive deep tendon reflexes
1. Flushing 4. Depressed respirations 5. Extreme muscle weakness (Adverse effects include flushing, depressed respirations, depressed DTRs, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum Mg levels) NCLEX
A woman in active labor has requested a regional anesthetic. She is currently 5 cm dilated. The health care provider (HCP) has prescribed an epidural block. Which nursing intervention would be implemented after the epidural block has been placed? 1. Palpate the bladder at frequent intervals. 2. Encourage the woman to walk to progress the labor. 3. Assess the blood pressure frequently for hypertension. 4. Encourage the woman to assume a supine position after the epidural has been placed.
1. Palpate the bladder at frequent intervals. (pt loses sensation that she needs to urinate - full bladder impedes progression of fetus during labor) NCLEX
Butorphanol tartrate by intravenous push is prescribed for a client in labor. The nurse recognizes which assessment findings to be side or adverse effects of this medication? (Select all that apply) 1. Tinnitus 2. Syncope 3. Bradycardia 4. Palpitations 5. Increased thirst 6. Nausea and vomiting
1. Tinnitus 2. Syncope 4. Palpitations 6. Nausea and vomiting NCLEX
Methylergonovine is prescribed for a woman with postpartum hemorrhage caused by uterine atony. Before administering the medication, the nurse should check which most important client parameter? 1. Lochial flow 2. Urine output 3. Temperature 4. Blood pressure
4. Blood pressure (nurse must check BP before administering) NCLEX
A client with severe preeclampsia is receiving intravenous magnesium sulfate. The nurse is reviewing the laboratory results and determines that which magnesium level is within the therapeutic range? 1. 1 mEq/L (0.5 mmol/L) 2. 3 mEq/L (1.5 mmol/L) 3. 5 mEq/L (2.5 mmol/L) 4. 10 mEq/L (5 mmol/L)
3. 5 mEq/L (2.5 mmol/L) (therapeutic range is 4-7 mEq/L) NCLEX
A nurse is caring for a newborn whose mother received Mg sulfate to treat preterm labor. Which of the following clinical manifestations in the newborn indicates toxicity due to the Mg sulfate therapy? a. respiratory depression b. hypothermia c. hypoglycemia d. jaundice
a. respiratory depression ATI
The nurse has a routine prescription to administer an injection of phytonadione (Vitamin K) to the newborn. Which statement made by the new mother indicates that teaching on this medication was effective? 1. "I know that this medication is used to stimulate the liver to produce vitamin K." 2. "I know that this medication is used to prevent clotting abnormalities in the newborn." 3. "I know that this medication is used to prevent vitamin deficiency of fat-soluble vitamins." 4. "I know that this medication is used to supplement my baby, because breast milk and formula are low in vitamin K."
2. "I know that this medication is used to prevent clotting abnormalities in the newborn." NCLEX
The senior nursing student is assigned to care for a client with severe preeclampsia who is receiving an intravenous infusion of magnesium sulfate. The co-assigned registered nurse asks the student to describe the actions and effects of this medication. Which statement, if made by the student, indicates the need for further teaching? 1. "It decreases the frequency and duration of uterine contractions." 2. "It increases acetylcholine, blocking neuromuscular transmission." 3. "It decreases the central nervous system activity, acting as an anticonvulsant." 4. "It produces flushing and sweating due to decreased peripheral blood pressure."
2. "It increases acetylcholine, blocking neuromuscular transmission." (Mg sulfate decreases acetylcholine) NCLEX
The rubella vaccine has been prescribed for a new mother. Which statement should the postpartum nurse make when providing information about the vaccine to the client? 1. "You should avoid sexual intercourse for 2 weeks after administration of the vaccine." 2. "You should not become pregnant for 2 to 3 months after administration of the vaccine." 3. "You should avoid heat and extreme temperature changes for 1 week after administration of the vaccine." 4. "You must sign an informed consent because anaphylactic reactions can occur with the administration of this vaccine."
2. "You should not become pregnant for 2 to 3 months after administration of the vaccine." NCLEX
The nurse is caring for a client in labor who is receiving oxytocin (Pitocin) by intravenous infusion to stimulate uterine contractions. Which assessment finding should indicate to the nurse that the infusion needs to be discontinued? 1. Increased urinary output 2. A fetal heart rate of 90 beats/min 3. Three contractions occurring within a 10-minute period 4. Adequate resting tone of the uterus palpated between contractions
2. A fetal heart rate of 90 beats/min (normal FHR = 110-160 beats/min: bradycardia or late or variable decelerations indicate fetal distress and the need to discontinue the oxytocin) NCLEX
magnesium sulfate: drug class, indications (2)
tocolytic -stopping preterm labor, preventing preterm birth -preventing and controlling seizures in preeclampic and eclamptic pts
A client in preterm labor (31 weeks) who is dilated to 4 cm has been started on magnesium sulfate and contractions have stopped. If the client's labor can be inhibited for the next 48 hours, the nurse anticipates a prescription for which medication? 1. Nalbuphine 2. Betamethasone 3. Rho(D) immune globulin 4. Dinoprostone vaginal insert
2. Betamethasone (steroid for fetal lung development in preterm labor) NCLEX
Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority nursing assessment? 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes
2. Blood pressure NCLEX
The nurse is preparing to administer beractant (Survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular
2. Intratracheal NCLEX
A pregnant client is receiving magnesium sulfate for the management of preeclampsia. The nurse determines that the client is experiencing toxicity from the medication if which findings are noted on assessment? (Select all that apply) 1. Proteinuria of 3+ 2. Respirations of 10 breaths/minute 3. Presence of deep tendon reflexes 4. Urine output of 20 mL in an hour 5. Serum magnesium level of 4 mEq/L
2. Respirations of 10 breaths/minute 4. Urine output of 20 mL in an hour (signs of toxicity: respiratory depression, loss of DTRs, sudden decline in FHR and maternal HR and BP, respiratory rate <12/min, urine output <25 mL/hr) NCLEX
A woman with preeclampsia is receiving magnesium sulfate. Which indicates to the nurse that the magnesium sulfate therapy is effective? 1. Scotomas are present. 2. Seizures do not occur. 3. Ankle clonus is noted. 4. The blood pressure decreases.
2. Seizures do not occur. NCLEX
The client delivered a newborn baby 3 hours ago. The assigned nurse is reviewing the electronic health record to determine if the new mother is a candidate for Rh immune globulin administration. Which criteria must be present in order to administer this medication correctly? (Select all that apply.) 1. The father must be Rh negative. 2. The mother must be Rh negative. 3. The newborn must be Rh positive. 4. The indirect Coombs' test must be negative. 5. The newborn must be a second or subsequent child delivered to this mother.
2. The mother must be Rh negative. 3. The newborn must be Rh positive. 4. The indirect Coombs' test must be negative. (Following the birth of a first child, if eligible, the mother should receive Rh immune globulin as a protection against the development of Rh isoimmunization in her next child. To be a candidate, the mother must be Rh negative, the newborn must be Rh positive, and the father must be Rh positive. The indirect Coombs' test should be negative and not contain any Rh antibodies.) NCLEX
A rubella titer result of a 1-day postpartum client is less than 1:8, and a rubella virus vaccine is prescribed to be administered before discharge. The nurse provides which information to the client about the vaccine? (Select all that apply) 1. breast-feeding needs to be stopped for 3 months 2. pregnancy needs to be avoided for 1-3 months 3. the vaccine is administered by the subcutaneous route 4. exposure to immunosuppressed individuals needs to be avoided 5. a hypersensitivity reaction can occur if the client has an allergy to eggs 6. the area of injection needs to be covered with sterile gauze for 1 week
2. pregnancy needs to be avoided for 1-3 months 3. the vaccine is administered by the subcutaneous route 4. exposure to immunosuppressed individuals needs to be avoided 5. a hypersensitivity reaction can occur if the client has an allergy to eggs NCLEX
The nurse is administering an intravenous analgesic to a laboring woman. The woman inquires as to why the nurse is waiting for a contraction to begin before she infuses the medication into the intravenous line. Which is the nurse's most appropriate response? 1. "The medication will only affect you and your pain level when given during a contraction." 2. "The medication will provide the most optimal relief when it is given while your pain level is highest." 3. "Because the uterine blood vessels constrict during a contraction, the fetus will be less affected by the medication." 4. "You will experience a lower incidence of adverse effects from the medication when administered during a contraction."
3. "Because the uterine blood vessels constrict during a contraction, the fetus will be less affected by the medication." NCLEX
The nurse is preparing to administer an injection of vitamin K to a newborn and provides the mother with information about the injection. Which information should the nurse provide? 1. "It's a single injection given by the intravenous route." 2. "The injection is given after birth and then again one month later." 3. "The injection is extremely important to prevent bleeding in your baby." 4. "It's fine if you want to refuse giving it to your baby. Once your baby starts on baby food vitamin K deficiency will be replaced."
3. "The injection is extremely important to prevent bleeding in your baby." NCLEX
The nurse is preparing to administer an analgesic to a client in labor. Which analgesic is contraindicated for a client who has a history of opioid dependency? 1. Fentanyl 2. Morphine sulfate 3. Butorphanol tartrate 4. Meperidine hydrochloride (Demerol)
3. Butorphanol tartrate (Butorphanol tartrate is an opioid analgesic that can precipitate withdrawal symptoms in an opioid-dependent client) NCLEX
The nurse in the postpartum unit notes that a new mother was given methylergonovine intramuscularly following delivery. What assessment finding indicates that the medication was effective? 1. Lochia that is serous 2. Normal blood pressure 3. Decreased uterine bleeding 4. Decreased uterine contractions
3. Decreased uterine bleeding (used to prevent or control postpartum hemorrhage by contracting the uterus) NCLEX
A pregnant woman of 30 weeks' gestation is admitted to the maternity unit in preterm labor. The woman asks the nurse about the purpose of betamethasone, which has been prescribed by the health care provider (HCP). The nurse should tell the client that the medication will promote which action? 1. Delay delivery. 2. Prevent membrane rupture. 3. Enhance fetal lung maturity. 4. Stop the premature uterine contractions.
3. Enhance fetal lung maturity. NCLEX
A client in preterm labor is being started on intravenous magnesium sulfate to stop the contractions. Several hours later, when the nurse is performing an assessment, the following data are obtained: blood pressure 110/66 mmHg, pulse 66 beats per minute, respirations 10 breaths per minute, and deep tendon reflexes absent. What should the nurse do next? 1. Institute seizure precautions. 2. Prepare for a precipitous delivery. 3. Prepare to administer calcium gluconate as an antidote for magnesium toxicity. 4. Increase the rate of magnesium sulfate, as the desired outcome has not yet been achieved.
3. Prepare to administer calcium gluconate as an antidote for magnesium toxicity. NCLEX
A client with preeclampsia is receiving magnesium sulfate. The nurse should assess the client closely for which sign of magnesium toxicity? 1. Proteinuria 2. Presence of deep tendon reflexes 3. Respiratory rate of 10 breaths/minute 4. Serum magnesium level of 5 mEq/L
3. Respiratory rate of 10 breaths/minute (therapeutic Mg level = 4-7 mEq/L) NCLEX
Rho(D) immune globulin is prescribed for a client after delivery and the nurse provides information to the client about the purpose of the medication. The nurse determines that the woman understands the purpose if the woman states that it will protect her next baby from which condition? 1. Having Rh-positive blood 2. Developing a rubella infection 3. Developing physiological jaundice 4. Being affected by Rh incompatibility
4. Being affected by Rh incompatibility NCLEX
On assessment, a newborn is exhibiting cyanosis, tachypnea, nasal flaring, and grunting. Respiratory distress syndrome is diagnosed, and the health care provider (HCP) prescribes surfactant replacement therapy. Through which route should the nurse prepare to administer this medication? 1. Orally mixed in water 2. Intravenously through a burette 3. Subcutaneously in the anterior thigh 4. Endotracheally through the endotracheal tube
4. Endotracheally through the endotracheal tube NCLEX
The nurse administers erythromycin ointment (0.5%) to the eyes of a newborn and the mother asks the nurse why this is performed. Which explanation is best for the nurse to provide about neonatal eye prophylaxis? 1. Protects the newborn's eyes from possible infections acquired while hospitalized. 2. Prevents cataracts in the newborn born to a woman who is susceptible to rubella. 3. Minimizes the spread of microorganisms to the newborn from invasive procedures during labor. 4. Prevents an infection called ophthalmia neonatorum from occurring after delivery in a newborn born to a woman with an untreated gonococcal infection.
4. Prevents an infection called ophthalmia neonatorum from occurring after delivery in a newborn born to a woman with an untreated gonococcal infection. NCLEX
The nurse is planning to administer an intramuscular injection of vitamin K to a newborn. To administer the injection, which site should the nurse select? 1. The gluteal muscle 2. The lower aspect of the rectus femoris muscle 3. The medial aspect of the upper third of the vastus lateralis muscle 4. The lateral aspect of the middle third of the vastus lateralis muscle
4. The lateral aspect of the middle third of the vastus lateralis muscle NCLEX
Shortly after receiving epidural anesthesia, a laboring woman's blood pressure drops to 95/43 mm Hg. Which immediate actions should the nurse take? (Select all that apply.) 1. Prepare for delivery. 2. Administer a tocolytic. 3. Administer an opioid antagonist. 4. Turn the woman to a lateral position. 5. Increase the rate of the intravenous infusion. 6. Administer oxygen by face mask at 10 L/minute.
4. Turn the woman to a lateral position. 5. Increase the rate of the intravenous infusion. 6. Administer oxygen by face mask at 10 L/minute. -maternal hypotension = ↓ placental perfusion -pt to side = uterus off vena cava = ↑ circulation -↑ IV infusion = ↑ blood volume = ↑ BP -oxygen administration = ↑ oxygen to fetus NCLEX
A G1P0 client's cervix is 4 cm dilated. She tells the nurse, "I'm in pain, but I'm afraid that medication might harm my baby." Which response by the nurse is the most therapeutic regarding pain medication during labor? a. "Pain medications do affect the baby, but so do pain and stress." b. "You are correct in your belief that medication might harm your baby." c. "The doctor has ordered only a small amount, so your baby will be quite safe." d. "The new medications are so much safer than the old medications."
a. "Pain medications do affect the baby, but so do pain and stress." text
A nurse educator in the labor and delivery unit is reviewing the use of chemical agents to promote cervical ripening with a group of newly hired nurses. Which of the following statements by a nurse indicates understanding of the teaching? a. "They are administered in an oral form." b. "They act by absorbing fluid from tissues." c."They promote dilation of the os." d."They include an amniotomy."
a. "They are administered in an oral form." -hygroscopic sponges (absorb fluid from surrounding tissues to enlarge cervical opening) = mechanical -mechanical and physical methods promote cervical ripening by dilation -amniotomy = mechanical ATI
A nurse is teaching a client about terbutaline. Which of the following statements by the client indicates an understanding of the teaching? a. "This medication will stop my contractions." b. "This medication will prevent vaginal bleeding." c. "This medication will promote blood flow to my baby." d. "This medication will increase my prostaglandin production."
a. "This medication will stop my contractions." ATI Pharm
A prenatal client has been scheduled for induction of labor and tells the nurse she does not understand why her cervix needs to be softened with misoprostol. She asks, "Won't it be faster if we just start the Pitocin?" Which explanation from the nurse would be most accurate? a. Cervical ripening decreases the likelihood of failed induction. b. It is advisable to decline cervical ripening because it does not improve outcomes. c. Softening of the cervix does not occur in normal labor, but is required for induction. d. Misoprostol is the only effective method of cervical ripening.
a. Cervical ripening decreases the likelihood of failed induction. text
A nurse is preparing to administer naloxone to a newborn. Which of the following conditions can require administration of this medication? a. IV narcotics administered to the mother during labor b. maternal drug use c. hyaline membrane disease d. meconium aspiration
a. IV narcotics administered to the mother during labor (respiratory depression due to narcotic toxicity) ATI
A client is 24 hours postpartum and saturating a pad every 2 hours with lochia rubra. Her fundus is at the umbilicus. Based on these findings, what medication would the nurse anticipate the primary healthcare provider or nurse-midwife ordering for this client? a. Methylergonovine maleate (Methergine) b. Oxycodone (Percodan) c. Ibuprofen (Motrin) d. Carboprost (Hemabate)
a. Methylergonovine maleate (Methergine) -Methergine is the treatment of choice for subinvolution (fundus is too high) -Percodan and Motrin are ordered for pain management -Hemabate is used for immediate postpartum hemorrhage related to uterine atony text
The nurse is administering Benadryl per standing order to treat which commonly occurring side effect during epidural infusion? a. Pruritus b. Hypotension c. Nausea and vomiting d. General sedation
a. Pruritus text
A client on the postpartum unit reports a severe headache to her nurse. That client's vital signs are within normal limits and she has no history of headaches. What intervention recorded in the labor record can the nurse identify as a cause for the headache? a. Spinal block b. Narcotic administration c. IV fluid bolus d. Administration of nonsteroidal anti-inflammatory medications (NSAIDs)
a. Spinal block (postpartum headache may result from puncturing the dura mater for a spinal block) text
A nurse is assessing a client who received carboprost for postpartum hemorrhage. Which of the following findings is an adverse effect of this medication? a. hypertension b. hypothermia c. constipation d. muscle weakness
a. hypertension ATI
A nurse is caring for a client who has a new prescription for oxytocin to stimulate uterine contractions. Which of the following interventions should the nurse make? (Select all that apply) a. use an infusion pump for medication administration b. obtain vital signs frequently and with every dosage change c. stop infusion if uterine contractions occur every 4 min and last 45 seconds d. increase medication infusion rate rapidly e. monitor fetal heart rate continuously
a. use an infusion pump for medication administration b. obtain vital signs frequently and with every dosage change e. monitor fetal heart rate continuously (the goal is contractions that last 1 min or less every 2-3 min) ATI Pharm
The provider places an order for butorphanol, 2 mg IV x 1 dose. What are the most appropriate nursing actions immediately following its administration? a. Measure intake and output. b. Raise the side rails and place the call button within the client's reach. c. Evaluate the effectiveness of pain relief. d. Obtain an order for the timing of subsequent doses.
b. Raise the side rails and place the call button within the client's reach. (adverse effects: disorientation and dizziness) text
A nurse is caring for a client with an oxytocin infusion. What is the correct nursing action prior to increasing the oxytocin rate? a. Assess cervical dilation. b. Review the fetal monitor tracing. c. Evaluate the need for analgesia. d. Assess maternal temperature.
b. Review the fetal monitor tracing. text
The nurse is assessing a client receiving magnesium for neuroprotection in the setting of preterm rupture of membranes at 25 weeks' gestation. Which finding should be reported to the primary healthcare provider? a. Maternal complaints of muscle weakness b. Temperature of 100.6°F c. Blood pressure 90/50 d. Minimal FHR variability
b. Temperature of 100.6°F (Elevation of the maternal temp in the presence of ruptured membranes may be a sign of chorioamnionitis. Maternal complaints of muscle weakness and minimal FHR variability are benign side effects of Mg. A maternal BP of 90/50 in the 2nd trimester is a normal finding.) text
Nurse is caring for a pt who is at 28 weeks gestation and experiencing preterm labor. Which of the following medications should the nurse plan to administer? a. oxytocin b. nifedipine c. dinoprostone d. misoprostol
b. nifedipine (calcium channel blocker, tocolytic) ATI
A nurse is caring for a client who is in labor and receiving IV opioid analgesics. Which of the following actions should the nurse take? a. instruct the client to self-ambulate every 2 hr b. offer oral hygiene every 2 hr c. anticipate medication administration 2 hr prior to delivery d. monitor fetal heart rate every 2 hr
b. offer oral hygiene every 2 hr (adverse effects = dry mouth, nausea, vomiting) ATI Pharm
A nurse is reviewing a new prescription for terbutaline with a client who has a hx of preterm labor. Which of the following client statements indicates understanding of the teaching? a. "I can increase my activity now that I've started on this medication." b. "I will increase my daily fluid intake to 3 quarts." c. "I will report increasing intensity of contractions to my doctor." d. "I am glad this will prevent preterm labor."
c. "I will report increasing intensity of contractions to my doctor." (symptoms of preterm labor) ATI Pharm
The nurse is to administer naloxone (Narcan) intravenously. Which medication order would be the most appropriate initial dose to counteract a narcotic-induced maternal respiratory depression? a. 0.125-0.25 mg b. 0.2-0.4 mg c. 0.4-2.0 mg d. 3.0-4.0 mg
c. 0.4-2.0 mg text
A nurse is caring for a client who has preeclampsia and is receiving Mg sulfate IV continuous infusion. Which of the following findings should the nurse report to the provider? a. 2+ DTRs b. 2+ pedal edema c. 24 mL/hr urine output d. respirations 12/min
c. 24 mL/hr urine output (urine output <25-30 mL/hr is associated with Mg sulfate toxicity) ATI Pharm
A nurse is discussing epidural anesthesia with a client who is receiving oxytocin for induction of labor. Which of the following statements should the nurse make? a. "An epidural given too early during labor can cause maternal hypertension." b. "An epidural given too early during labor will not be effective in active labor." c. "An epidural given too early can cause fetal depression." d. "An epidural given too early can prolong labor."
d. "An epidural given too early can prolong labor." ATI
The nurse is discussing betamethasone's effects on fetal lung maturity with a group of students. Which statement by a student demonstrates understanding of the effects of betamethasone? a. "It prevents delivery until the lungs are mature." b. "It increases capillary permeability in the lungs" c. "It alters the oxygen-carrying capacity of fetal hemoglobin." d. "It promotes surfactant production in the alveoli."
d. "It promotes surfactant production in the alveoli." text
hepatitis B vaccine: who, when
newborns born to infected mothers should receive hepatitis B vaccine and immune globulin within 12 hrs of birth (ATI p 122)
butorphanol tartrate
opioid analgesic
nifedipine adverse effect
orthostatic hypotension (calcium channel blocker)
betamethasone: indication
preterm labor 24-34 weeks gestation (ATI) 28-32 weeks gestations (NCLEX)
misoprostol: drug class, indications (2)
prostaglandin -cervical ripening -postpartum hemorrhage -NCLEX p 395 -ATI OB p 99, 136 -text p 451, 714