Adam's 8

A pregnant client suspected of drug abuse is admitted to the emergency department. The nurse plans to teach the client about which complications associated with drug use during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Preterm birth 2. Low birth weight 3. Birth defects 4. Allergies to narcotics 5. Increased labor

Correct Answer: 1,2,3 Rationale 1: Many illicit drugs can cause preterm birth. Rationale 2: Many illicit drugs can cause low birth weight. Rationale 3: Many illicit drugs can cause birth defects. Rationale 4: No research suggests that drug use can cause allergies to narcotics. Rationale 5: No research suggests that drug use can cause increased labor.

The nurse is planning care for a pregnant client prone to substance abuse. When the client states, "My baby isn't getting my drugs; I am," which response by the nurse is the most appropriate? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "Most illicit drugs will cross the placenta and hurt the baby." 2. "Even drugs that do not cross the placenta can hurt your baby by preventing nutrients from getting across the placenta." 3. "Research shows taking drugs can cause your baby to be born too early." 4. "You are correct. You are far enough along in your pregnancy that drugs will not harm your baby." 5. "If you continue to take drugs, it will make you have a very irritable infant."

Correct Answer: 1,2,3 Rationale 1: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Rationale 2: Certain drugs can cause constriction of placental blood vessels, resulting in decreased nutrient exchange. Rationale 3: Most illicit drugs cross the placenta and can cause premature birth, low birth weight, birth defects, and withdrawal symptoms. Rationale 4: The effect the drug has on the fetus will depend on the stage of fetal development. There is a greater potential for harm during the first trimester but nutrients to the fetus can be compromised by drug abuse during the latter stages of pregnancy. Rationale 5: While withdrawal can cause irritability in infants born to drug addicts, the risk for irritability is not the reason for abstaining from drug use during pregnancy.

For which client would the nurse expect the health care provider to continue prescribed medications during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The client recently diagnosed with gonorrhea 2. The client with a history of frequent asthma attacks 3. The client with hypertension 4. The client with frequent insomnia 5. The client with a family history of stroke

Correct Answer: 1,2,3 Rationale 1: Sexually transmitted diseases are treated during pregnancy. Rationale 2: Asthma is treated during pregnancy. Rationale 3: Hypertension is treated during pregnancy. Rationale 4: Insomnia would not be treated during pregnancy. Rationale 5: This client would not be treated unless she has a history of stroke.

The nurse is preparing a teaching plan for an adolescent postpartum mother. Which topic will the nurse include in the teaching plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Most medications are secreted into breast milk 2. The new mother's insulin will not be secreted into her breast milk. 3. Over-the-counter (OTC) drugs and herbal products are secreted into breast milk and have the potential to cause harm to the infant. 4. Topical medications must be avoided as these also are secreted into breast milk. 5. Most drugs are safe to take right after breast-feeding because they have not reached the blood stream yet.

Correct Answer: 1,2,3 Rationale 1: The majority of drugs are secreted into breast milk. Rationale 2: Insulin molecules are too large to be secreted into breast milk. Rationale 3: OTC drugs and herbal products can be secreted into breast milk and have the potential to harm the infant. All products should be approved by the provider prior to use. Rationale 4: Topical medications are not secreted into breast milk and are safe to use during breast-feeding. Topical medications could be ingested by the infant if applied to the nipple or breast. Rationale 5: Drugs should only be taken during breast-feeding if the benefits to the mother outweigh the risks to the infant

When possible, drug therapy is postponed until after pregnancy and lactation. Which acute and chronic conditions must be managed during pregnancy? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Epilepsy. 2. Serious cystic acne. 3. Sexually transmitted diseases. 4. Gestational diabetes. 5. Hypertension.

Correct Answer: 1,3,4,5 Rationale 1: Epilepsy is a preexisting disease. It would not be wise to discontinue therapy during pregnancy and lactation. Rationale 2: Cystic acne may be treated with isotretinoin (Accutane). Isotretinoin is a Class X drug and can cause fetal brain damage. Other antibiotics such as tetracycline are Class D and should not be used in pregnancy. Rationale 3: Sexually transmitted diseases can harm the fetus. Rationale 4: Gestational diabetes is a complication related to pregnancy that must be treated for the safety of both the mother and growing fetus. Rationale 5: If hypertension is present prior to pregnancy, it would be unwise to discontinue therapy during pregnancy and lactation.

The nurse teaching a parenting class would stress what information about adverse drug reactions? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Common drug effects seen in breast-feeding infants include diarrhea and irritability. 2. The concentration of drugs in breast milk is very high. 3. Effects on the infant can be very serious. 4. There is rarely any effect on the infant. 5. The concentration of drugs in breast milk is very low but may still result in adverse drug effects in an infant.

Correct Answer: 1,3,5 Rationale 1: Common drug effects in breast-fed infants include diarrhea, constipation, sedation, and irritability. Rationale 2: The concentration is actually very low. Rationale 3: The effects can be very serious depending on the drug ingested. Rationale 4: There is always an effect from any drug. The seriousness varies. Rationale 5: Even a low drug concentration in breast milk can cause very serious effects to the infant

The nurse knows that pregnancy affects the absorption, distribution, metabolism, and excretion of drugs. Which one is the least affected by pregnancy? 1. Distribution 2. Metabolism 3. Excretion 4. Absorption

Correct Answer: 2 Rationale 1: Distribution results in greater hemodilution of plasma proteins and drugs. Rationale 2: Metabolism is the least affected by pregnancy. Rationale 3: Excretion is enhanced by increases in renal plasma flow, glomerular filtration rate, creatinine clearance, and renal tubular reabsorption. Rationale 4: Absorption is delayed related to changes in the gastrointestinal tract during pregnancy

The pregnant client plans to breast-feed her baby. She asks the nurse about the use of herbal products during breast-feeding. Which response by the nurse is the most appropriate? 1. "That should be fine as long as at least 12 hours pass between the time you use the product and when you breast-feed." 2. "Most drugs can be transferred to the infant during breast-feeding, so this is not recommended." 3. "Herbal products are considered natural, so it should be fine to use them during breast-feeding." 4. "Be sure to check the label to see whether the herbal product can be used during breast-feeding."

Correct Answer: 2 Rationale 1: Research data does not support this statement. Rationale 2: The majority of drugs are secreted into breast milk to some extent. Rationale 3: Herbal products can be transferred through breast milk and can be toxic to the newborn. Rationale 4: Herbal products may not have to include factual information on their labels. All drugs should be discussed with a provider prior to consuming while breast-feeding.

During a class about the use of medications during pregnancy, the nurse determines that additional information is required when a client makes which statement? 1. "Exposure to some medications can result in my baby's death or in malformations." 2. "The baby can only be harmed by medication during the first trimester." 3. "If I breast-feed my baby, drugs can come through my breast milk." 4. "It is important not to take over-the-counter (OTC) drugs during my pregnancy."

Correct Answer: 2 Rationale 1: Some medications, when given during pregnancy, are teratogens. Teratogens have varying effects on body systems, from minor to severe. Rationale 2: Teratogens can affect different body systems at different times during the pregnancy. Rationale 3: Most maternal medications can be transferred to the infant through the ingestion of breast milk. Rationale 4: OTC drugs have the same potential risk for causing malformations to the fetus as do prescription drugs. Global

A pregnant client tells the nurse that her prescribed medication is not as effective as it was before her pregnancy. Which response by the nurse is the most appropriate? 1. "This is because your blood volume has increased." 2. "This is because high estrogen levels increase stomach acid, which may decrease absorption." 3. "Maybe the medication has expired; check the label." 4. "Tell me how you have been taking your medication."

Correct Answer: 2 Rationale 1: The increase in blood volume would result in higher concentrations of "free" drug in the plasma. This would result in an increase in drug response, not decreased effectiveness. Rationale 2: High estrogen levels can increase hydrochloric acid in the stomach, which can affect the absorption of some medications. Rationale 3: This is not the best response. If she routinely took the medication before her pregnancy, it is unlikely the medication would have expired. Rationale 4: This might be an appropriate question after other factors have been established. This is not the best response.

The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which factor would the nurse need to emphasize about the first trimester of pregnancy? 1. There is very little chance of the fetus being affected by teratogens during this phase. 2. Teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion. 3. This is the preconceptional period of the pregnancy. 4. Teratogenic agents during this phase do not cause severe malformations in the fetus

Correct Answer: 2 Rationale 1: This is the phase when teratogens have the greatest effect on the embryo. Rationale 2: In this phase, all the body systems form. Rationale 3: This is the embryonic period. Rationale 4: This is the phase when teratogens have the greatest effect on the embryo resulting in possible severe malformations.

What should the nurse educator teach as a common reason for difficulty in assessing for side effects of medications during pregnancy? 1. The mother is so uncomfortable with the pregnancy that she chooses to ignore the adverse effects. 2. Adverse effects of medications are not experienced as often with pregnant women. 3. Adverse effects of medications are often similar to common discomforts of pregnancy. 4. The mother has increased blood volume, so the drugs are not strong enough to produce side effects.

Correct Answer: 3 Rationale 1: The mother would not ignore the adverse effects, because of potential harm to the fetus. Rationale 2: Pregnant women have the same potential for experiencing adverse effects from drugs as do women who are not pregnant. Rationale 3: Nausea, vomiting, abdominal cramps, flushed skin, and diaphoresis are also normal symptoms in pregnancy. Rationale 4: Volume of blood may increase the strength of medication but this will not result in difficulty assessing side effects

The nurse educator is explaining the factors that impact the transfer of medications across the placenta. Which factor would be responsible for higher concentrations of a drug being transferred to the fetus through the placenta? 1. Low degree of metabolic activity of the placenta 2. Increased blood flow to the placenta 3. Plasma drug level in the mother 4. Increased blood volume of the mother

Correct Answer: 3 Rationale 1: The placenta has a high metabolic activity level. Rationale 2: Decreased blood flow to the placenta results in trapped circulating drugs; therefore, higher levels of drug concentration would be present in the fetus. Rationale 3: Higher concentrations of drugs in the maternal blood lead to higher levels of circulating drug to the placenta. Rationale 4: Increased blood volume of the mother does not affect amount of drug that is transferred to the fetus

The nurse tells the expectant mothers during their last prenatal class that their fetus might receive a larger dose of a drug in the later period of their pregnancy. Which processes in the mother's body systems are responsible for this action? 1. Blood flow to placenta increases, and placental vascular membranes become thicker. 2. Blood flow to placenta decreases, and placental vascular membranes become thicker. 3. Blood flow to placenta increases, and placental vascular membranes become thinner. 4. Blood flow to placenta decreases, and placental vascular membranes become thinner

Correct Answer: 3 Rationale 1: The placenta vascular membranes become thinner. Rationale 2: The blood flow to the placenta increases and the placenta vascular membranes become thinner. Rationale 3: Blood flow to placenta increases, and placental vascular membranes become thinner, allowing for more substances to be transferred through the placenta. Rationale 4: The blood flow to the placenta increases.

Student nurses are learning about the Food and Drug Administration (FDA) pregnancy categories. What is the best information for the nurse educator to include in the lecture? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. FDA pregnancy categories for individual drugs seldom change once they are established. 2. FDA pregnancy categories are based on clinical human studies. 3. FDA pregnancy categories provide a framework for safe use of drugs in pregnant women. 4. FDA pregnancy category X has been associated with teratogenic effects. 5. FDA pregnancy category C is safe to use during pregnancy.

Correct Answer: 3,4 Rationale 1: FDA pregnancy categories for individual drugs change as new information is obtained. Rationale 2: Testing drugs on humans to determine their ability to cause birth anomalies is illegal and unethical. Drugs are tested on pregnant animals. Rationale 3: FDA pregnancy categories provide a guideline for prescribers to help them choose the least teratogenic drug possible. Rationale 4: FDA pregnancy category X medications should never be given during pregnancy. Rationale 5: FDA pregnancy category C includes drugs that we do not have sufficient information for in order to determine their safety. This includes about two-thirds of all prescribed medications

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant client? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Tetracycline 2. ACE inhibitor antihypertensive medication 3. Methotrexate 4. Isotretinoin (Accutane) 5. Oral contraceptives

Correct Answer: 3,4,5 Rationale 1: Tetracycline is in category D, not category X. It should be avoided during pregnancy, and the nurse should alert the health care provider. Rationale 2: ACE inhibitor antihypertensive drugs are in category C and are considered safe during pregnancy. Rationale 3: Methotrexate is in category X and should be avoided during pregnancy. Rationale 4: Isotretinoin is in category X and should be avoided during pregnancy. Rationale 5: Oral contraceptives are in category X and should be avoided during pregnancy

The nurse recognizes that which physiological change during pregnancy can alter absorption of medication? 1. Decreased levels of progesterone cause a decrease in gastric tone and intestinal motility. 2. High estrogen levels cause decreased hydrochloric acid production, which may affect the absorption of certain acid labile drugs. 3. An enlarging uterus presses against the stomach, resulting in increased gastric emptying. 4. Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs.

Correct Answer: 4 Rationale 1: Increased levels of progesterone cause a decrease in gastric tone and intestinal motility. Rationale 2: High estrogen levels cause increased hydrochloric acid production, which may affect the absorption of certain acid labile drugs. Rationale 3: An enlarging uterus presses against the stomach, resulting in decreased gastric emptying. Rationale 4: Increased levels of progesterone increase pulmonary blood flow, resulting in higher serum levels for respiratory drugs.

The nurse is teaching a prenatal class for mothers with a past history of drug abuse. Which fact about the use of drugs with a breast-feeding infant would the nurse need to emphasize? 1. The infant might experience withdrawal symptoms and test positive for the drug for several hours following exposure. 2. The infant will not experience withdrawal symptoms and will not test positive for the drug following exposure 3. The infant might experience withdrawal symptoms and test positive for the drug for several days following exposure. 4. The infant might experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure.

Correct Answer: 4 Rationale 1: The infant could experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure. Rationale 2: The infant could experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure. Rationale 3: The infant could experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure. Rationale 4: The infant could experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure

A client admitted to the emergency department for vaginal bleeding is surprised to find she is in the third trimester of pregnancy. An ultrasound determines the fetus is not viable. The nurse recognizes that which drug could be responsible for the fetal demise? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Selective serotonin reuptake inhibitors (SSRIs) 2. Fluoroquinolone 3. Acetaminophen 4. Nonsteroidal anti-inflammatory drugs (NSAIDs) 5. Angio-converting enzyme inhibitor (ACE inhibitor)

Correct Answer: 4,5 Rationale 1: SSRI drugs are category C and do not cause fetal demise. Rationale 2: Fluoroquinolone is category C and does not cause fetal demise. Rationale 3: Acetaminophen is category B and does not cause fetal demise. Rationale 4: Nonsteroidal anti-inflammatory drugs (NSAIDs) can cause fetal demise in the third trimester. Rationale 5: ACE inhibitors are category D and can cause fetal demise