Maternity on point-meds only

Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage. Before administering the medication, a nurse contacts the health care provider who prescribed the medication if which of the following conditions is documented in the client's medical history? 1. Hypotension 2. Hypothyroidism 3. Diabetes mellitus 4. Peripheral vascular disease

4.Methylergonovine (Methergine), an ergot alkaloid, has vasoconstrictive effects. It could not be used for patients who have cardiovascular, hypertension, eclampsia, preclampsia, or peripheral vascular diseases.

Carboprost tromethamine is given IM in 0.25 mg doses. What is the max amount of doses that may be given?

8 dose max

A pregnant client in labor receives a dose of IV push butorphanol tartrate and suddenly feels rectal pressure. What is your priority? A. alert the NICU team B. administer Naloxone stat C. assist the client to the bathroom D. stop the butorphanol tartrate

A. alert the NICU team (Rectal pressure is a sign that the client is close to delivery. Because the dose of butorphanol tartrate (opioid analgesic) was given so close to delivery, the NICU team should be present because of the high risk for newborn respiratory depression.)

Regarding vaginal birth after cesarean (VBAC), which of the following statements is true? a. Misoprostol is contraindicated in women attempting a VBAC. b. After one successful VBAC, there remains an increased risk of neonatal and maternal complications in subsequent attempts. c. Research shows no significant correlation between maternal weight and successful VBAC. d. Healthcare costs are considerably higher for women who have a VBAC than for those who have a repeat cesarean birth.

Answer: a. Prostaglandin agents are contraindicated in women attempting a VBAC. Feedback: Misoprostol is contraindicated in women attempting a VBAC. After one successful VBAC, the risk of neonatal and maternal complications decreases in subsequent attempts. Research does show a significant correlation between maternal weight and successful VBAC. Healthcare costs are considerably lower for women who have a VBAC than for those who have a repeat cesarean birth.

The RN is getting ready to administer a medication to control postpartum hemorrhage to a nulliparous patient who has a history of asthma. What medication should the nurse question? A. methylergonovine B. carboprost C. dinoprostone D. oxytocin

B. carboprost

Methylergonovine (Methergine) is prescribed for a woman with postpartum hemorrhage, before administration the priority nursing assessment should be to check the..

Blood Pressure

What is the action of tranexamic acid (TXA)?

Contraction of the uterus

he 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

Correct Answer: 3,4 Rationale: Oxytocin stimulates uterine contractions and is a pharmacological method to induce labor. Late decelerations, a nonreassuring fetal heart rate pattern, is an ominous sign indicating fetal distress. Oxytocin infusion must be stopped when any signs of uterine hyperstimulation, late decelerations, or other adverse effects occur. Some health care providers prescribe the administration of oxytocin in 10-minute pulsed infusions rather than as a continuous infusion. This pulsed method, which is more like endogenous secretion of oxytocin, is reported to be effective for labor induction and requires significantly less oxytocin use. Drowsiness and fatigue may be caused by the labor experience. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

The nurse knows to monitor the pt receiving Carboprost tromethamine Hemabate for which side effects:

HTN (BP), ruptures (uterine tone), GI stress, shock, and bleeding.

A nurse is caring for a client who has received methylergonovine. Which of the following should the nurse identify and document as an adverse effect of the medication? 1-Hyperglycemia 2-Hypertension 3-Urinary retention 4-Hyporeflexia

Hypertension

A laboring client has received butorphanol (Stadol) IV 1 hour before birth. Which medication should be available to decrease the potential effects of Stadol in the newborn?

Narcan

What medications are used to treat postpartum hemorrhage

Oxytocin Methylergonovine - Never IV only IM and contrindicated with hypertension Carboprost - contraindicated with asthma Misoprostol - last resort TxA or Tranexamic Acid

Methylergonovine (methergine) is prescribed for a client with postpartum hemorrhage. Before administering the medication, a nurse contacts the health care provider who prescribed the medication if which of the following conditions is documented on the client's medical history?

peripheral vascular disease

What are the nursing consideration of tranexamic acid?

provide client education about TXA explain it has been show to decrease blood loss and prevent PPHCompatible with breastfeeding

What are the contraindications of tranexamic acid?

pt with a history of a thromboembolic event during pregnancy

The nurse in the labor room is caring for a client in the active stage of the first phase of labor. The nurse is assessing the fetal patterns and notes a late deceleration on the monitor strip. What is the most appropriate nursing action? 1.Administer oxygen via face mask. 2.Place the mother in a supine position. 3.Increase the rate of the oxytocin (Pitocin) intravenous infusion. 4.Document the findings and continue to monitor the fetal patterns.

1 Late decelerations are due to uteroplacental insufficiency and occur because of decreased blood flow and oxygen to the fetus during the uterine contractions. Hypoxemia results; oxygen at 8 to 10 L/minute via face mask is necessary. The supine position is avoided because it decreases uterine blood flow to the fetus. The client should be turned onto her side to displace pressure of the gravid uterus on the inferior vena cava. An intravenous oxytocin infusion is discontinued when a late deceleration is noted. The oxytocin would cause further hypoxemia because of increased uteroplacental insufficiency resulting from stimulation of contractions by this medication. Although the nurse would document the occurrence, option 4 would delay necessary treatment.

The nurse is assisting a client undergoing induction of labor at 41 weeks' gestation. The client's contractions are moderate and occurring every 2 to 3 minutes, with a duration of 60 seconds. An internal fetal heart rate monitor is in place. The baseline fetal heart rate has been 120 to 122 beats/minute for the past hour. What is the priority nursing action? 1.Notify the health care provider. 2.Discontinue the infusion of oxytocin (Pitocin). 3.Place oxygen on at 8 to 10 L/minute via face mask. 4.Contact the client's primary support person(s) if not currently present.

2 The priority nursing action is to stop the infusion of oxytocin. Oxytocin can cause forceful uterine contractions and decrease oxygenation to the placenta, resulting in decreased variability. After stopping the oxytocin, the nurse should reposition the laboring mother. Applying oxygen, increasing the rate of the intravenous (IV) fluid (the solution without the oxytocin), and notifying the health care provider are also actions that are indicated in this situation. Contacting the client's primary support person(s) is not the priority action at this time.

Methylergonovine (Methergine) is prescribed for a woman to treat postpartum hemorrhage. Before the admnistation of methylergonovine, the priority nursing assessment is to check the: 1. Uterine tone 2. Blood pressure 3. Amount of lochia 4. Deep tendon reflexes

2.Methylergonovine (Methergine), a ergot alkaloid, is used to control the postpartum bleeding by continuous uterine contraction. This may increase the client's blood pressure; therefore, before administer Methergine, the client's blood pressure needs to be assessed.

The nurse is preparing to care for a client in labor. The health care provider has prescribed an intravenous (IV) infusion of oxytocin (Pitocin). 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 Oxytocin is a uterine stimulant used to induce labor. Continuous electronic fetal monitoring should be implemented during an IV infusion of oxytocin. No data in the question indicate the need for complete bed rest or the need for antibiotics. Placing a code cart at the bedside of a client receiving an oxytocin infusion is not necessary.

Misoprostol has been ordered for a pregnant patient at 41 weeks' gestation. Which statement made by the patient indicates to the nurse that teaching about the use of misoprostol has been effective? 1. "Misoprostol enhances uteroplacental perfusion in an aging placenta." 2. "Misoprostol increases amniotic fluid volume." 3. "Misoprostol ripens the cervix in preparation for labor induction." 4. "Misoprostol stimulates the amniotic membranes to rupture."

3, Rationales Option 1: This is not an indication for misoprostol. Option 2: This is not an indication for misoprostol. Option 3: Misoprostol is used as a pharmacological method of cervical ripening in preparation of labor induction. Option 4: Although the membranes can rupture spontaneously during misoprostol administration, this is a side effect of the medication, not an indication. Textbook ref pg: 309, 129

A patient at 27 weeks' gestation is admitted for a 23-hour observation period to rule out preterm labor. The practitioner orders terbutaline. The order reads terbutaline 5 mg subcutaneously every 3 to 4 hours for contractions greater than six per hour. Based on this order, what should the nurse do? A. Immediately clarify the order with the practitioner because it is unusual. B. Administer the terbutaline as soon as possible so it will take effect before the patient experiences a progression of preterm labor. C. Wait until the practitioner arrives on the unit to clarify the terbutaline order. D. Do not administer the terbutaline but instead start magnesium sulfate because it more effectively treats preterm labor.

A. Immediately clarify the order with the practitioner because it is unusual.

1) The laboring client has rated her pain at 9 on a scale of 1 to 10, and she requests IV pain medication. She has refused epidural anesthesia, but her certified nurse-midwife (CNM) has ordered butorphanol tartrate (Stadol) for administration to the client. Which action should the nurse complete next? 1. Advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication. 2. Offer the woman epidural anesthesia once more and describe the effectiveness of this method of labor pain control. 3. Obtain maternal vital signs and assess the fetal heart rate (FHR). 4. Administer oxygen via face mask at 6 to 10 liters per minute.

Answer: 1 Explanation: 1. Prior to administration of medication, the nurse must explain the pharmacologic effects of the medication and obtain consent for administration. 2. The woman has refused epidural anesthesia but is authorized to receive butorphanol tartrate. The nurse's next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication. 3. Prior to obtaining maternal vital signs and assessing FHR, the nurse should advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication. 4. Routine oxygen administration is not indicated for administration of butorphanol tartrate to an asymptomatic patient in labor. The nurse's next step is to advise the woman as to the actions and contraindications associated with butorphanol tartrate and obtain her consent for administration of the medication.

Butorphanol tartrate has been ordered for pain for a laboring client. What should be the nurse's first action prior to administering the medication? a. Monitor fetal heart rate. b. Assess for allergies. c. Monitor maternal vital signs. d. Assess cervical dilation.

Answer: B Assess for allergies. Rationale: Prior to administering butorphanol tartrate for pain, the nurse should assess for allergies. Monitoring fetal heart rate, assessing cervical dilation, and monitoring maternal vital signs are appropriate interventions, but not as the first action. Butorphanol tartrate are narcotic agonists, and it is not used in conjunction with an epidural.

The nurse educator is creating an in-service for student nurses who are completing their mother-baby clinical rotation. When discussing misoprostol (Cytotec), which of the following components is incorrect and should be omitted from the educational content? a. The initial dosage of misoprostol for induction is 50 mcg. b. The safe dosing interval is 3-6 hours. c. Pitocin should not be administered less than 4 hours after the last misoprostol dose. d. Misoprostol should only be administered where uterine activity can be monitored continuously if needed.

Answer: b. Recurrent administration of misoprostol should exceed dosing intervals of more than 3-6 hoursFeedback: The initial dosage of misoprostol for induction is 25 mcg. Recurrent administration of misoprostol should be at intervals of 3-6 hours. Pitocin should not be administered less than 4 hours after the last misoprostol dose. Misoprostol should only be administered where uterine activity and fetal well-being can be monitored continuously if needed.

A nurse is administering terbutaline 0.25 mg subcutaneously as ordered by the practitioner. The patient's heart rate is 150 bpm, her blood pressure is 88/55 mm Hg, and she is shaking and complaining of chest discomfort. Which order can the nurse anticipate receiving? A. Continue the administration of terbutaline; these are normal adverse reactions. B. Administer propranolol. C. Administer a bolus with IV fluids. D. Start administering magnesium sulfate.

B. Administer propranolol.

10. The practitioner has ordered two doses of terbutaline 0.25 mg subcutaneously for a patient at 30 weeks' gestation. Before administering the second dose, what should the nurse assess? A. Lung sounds and deep tendon reflexes B. Apical heart rate and lung sounds C. Apical heart rate and urinary output D. Apical heart rate and sodium level

B. Apical heart rate and lung sounds

Terbutaline is labeled for use as a bronchodilator. It is used on an unlabeled basis to suppress preterm labor. What is the classification and mechanism of action of terbutaline? A. Terbutaline is an alpha-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the alpha-adrenergic receptor agonists are stimulated. B. Terbutaline is a beta-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the beta-adrenergic receptor agonists are stimulated. C. Terbutaline is a beta-adrenergic agonist that works by expanding smooth muscle, including the uterus, when the beta-adrenergic receptor agonists are stimulated. D. Terbutaline is an alpha-adrenergic agonist that works by contracting smooth muscle, including the uterus, when the alpha-adrenergic receptor agonists are stimulated.

B. Terbutaline is a beta-adrenergic agonist that works by relaxing smooth muscle, including the uterus, when the beta-adrenergic receptor agonists are stimulated.

A patient at 26 weeks' gestation presents to the labor and delivery unit in preterm labor. The practitioner orders terbutaline to be administered subcutaneously. On initial assessment, the patient's blood pressure is 180/99 mm Hg, and a urine dipstick test indicates +3 protein. The patient is also reporting visual disturbances. Why should the nurse contact the practitioner to clarify whether terbutaline is appropriate for this patient? A. Terbutaline is contraindicated in pregnancies at 26 weeks' gestation. B. Terbutaline is contraindicated in patients with severe preeclampsia. C. Terbutaline is more effective as a maintenance tocolytic than as a first-line tocolytic. D. Terbutaline is limited to first-line tocolytics.

B. Terbutaline is contraindicated in patients with severe preeclampsia.

Terbutaline is ordered for preterm labor in a patient at 30 weeks' gestation. Ten minutes earlier, she received an initial dose of terbutaline 0.25 mg subcutaneously. The nurse completes an assessment. The patient's heart rate is 110 bpm, the FHR is classified as Category I (normal) but is elevated 10 bpm above normal baseline, and the patient is reporting new-onset headache, nervousness, and flushing. What should the nurse do? A. Reassure the patient that her symptoms are not from the terbutaline. B. Notify the practitioner that the patient is having a possible allergic reaction to the medication. C. Continue to monitor the patient closely and explain that these are normal adverse reactions to terbutaline. D. Tell the patient that she is experiencing normal preterm labor symptoms.

C. Continue to monitor the patient closely and explain that these are normal adverse reactions to terbutaline.

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 appropriate response? 1."The medication provides pain relief during labor." 2."The medication will assist in increasing the contractions." 3."The medication will help prevent any nausea and vomiting." 4."The medication prevents respiratory depression in the newborn infant."

Correct Answer: 1 Rationale: Butorphanol tartrate is an opioid analgesic that provides systemic pain relief during labor. It does not relieve nausea, increase uterine contractions, or prevent respiratory depression in the newborn infant.

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

Correct Answer: 1,2,4,6 Rationale: The client in labor may be given parenteral analgesia during the first stage of labor, up to 2 to 3 hours before the anticipated delivery. Butorphanol tartrate is a medication that may be prescribed for pain relief. Bradycardia and increased thirst are not side or adverse effects of this medication.

A pregnant client is receiving oxytocin for the induction of labor. The nurse should immediately discontinue the oxytocin infusion if which is noted in the client? 1.Uterine atony 2.Severe drowsiness 3.Uterine hyperstimulation 4.Early decelerations of the fetal heart rate

Correct Answer: 3 Rationale: Oxytocin is a synthetic hormone that stimulates uterine contractions and commonly is used to induce labor. A major danger associated with oxytocin induction of labor is hyperstimulation of uterine contractions, which can cause fetal distress as a result of decreased placental perfusion. Therefore, oxytocin infusion must be stopped when any signs of uterine hyperstimulation are observed. Uterine atony and severe drowsiness do not indicate a need to discontinue the infusion. Early decelerations of the fetal heart rate are a reassuring sign and do not indicate fetal distress.

A patient at 32 weeks' gestation is admitted to the antepartum unit with significantly elevated blood glucose levels; the practitioner wants to rule out gestational diabetes. The patient recently received several doses of subcutaneous terbutaline for preterm contractions. What is one of the potential serious maternal adverse reactions to terbutaline? A. Seizures B. Hypoglycemia C. Hypoinsulinemia D. Hyperglycemia

D. Hyperglycemia

A nurse is assess a client who received carboprost for postpartum hemorrhage. What is an adverse effect of this medication?

Hypertension The nurse should recognize that carboprost is a vasoconstrictor that can cause hypertension

Carboprost tromethamine (Hemabate) should be avoided in pts with:

Kidney failure, asthma, or are in the 3rd trimester of pregnancy.

A patient who is four weeks postpartum has irregular bleeding of lochia rubra with her fundus measured at 1 cm below the umbilicus. Based on these findings, what medication would the nurse anticipate the physician or midwife ordering for this patient?

Methergine (methylergonovine maleate)* Methergine is the treatment of choice for subinvolution. Percodan and Motrin are ordered for pain management. Hemabate is used for immediate postpartum hemorrhage related to uterine atony.

The nurse knows the appropriate use of the drug carboprost tromethamine (hemabate) is:

Postpartum hemorrhaging and abortions during 13-20 weeks gestation.

A nurse is caring for four postpartum patients who each have an order for Methergine (methylergonovine maleate). Based on the data collected during the nurse's initial shift assessment, which patient would not receive the medication? a. The client with a hematocrit of 33%. b. The client with a white blood cell count of 22,000. c. The client with a temperature of 101oF. d. The client with a blood pressure of 156/94.

The patient with a blood pressure of 156/94* Hypertension is a side effect of this medication; therefore, Methergine is contraindicated for women with high blood pressure. Elevated temperature and elevated blood count are not contraindications for administering Methergine. Because Methergine is given to prevent or reverse postpartum hemorrhage, it may also help prevent a decrease in hematocrit levels.

A client who is 4 weeks postpartum has irregular bleeding of lochia rubra with her fundus measured at 1 cm below the umbilicus. Based on these findings, what medication would the nurse anticipate the physician or midwife ordering for this client? a. Ibuprofen. b. Methylergonovine maleate. c. Carboprost. d. Oxycodone.

b. Methylergonovine maleate.Rationale: Methylergonovine maleate is the treatment of choice for subinvolution. Oxycodone and Ibuprofen are ordered for pain management. Carboprost is used for immediate postpartum hemorrhage related to uterine atony.

he nurse is preparing to administer terbutaline (Brethine) to a pregnant patient who is in preterm labor. What questions should the nurse ask the patient before drug administration to promote drug safety? Select all that apply. 1"Do you ever have migraine headaches?" 2"Do you have pregnancy-induced diabetes?" 3"Do you suffer from nausea and vomiting?" 4"Do you suffer from any cardiac disease?"5"Do you experience urinary frequency?

correct 1"Do you ever have migraine headaches?" 2"Do you have pregnancy-induced diabetes?" 4"Do you suffer from any cardiac disease?"

The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion?a. Blood pressure of 80/60 mm Hg b. Short episode of hyperglycemia c.Irregular episodes of dysrhythmias d. Heart rate of less than 120 beats/min

correct a Blood pressure of 80/60 mm Hg

What are the side effects of tranexamic acid?

seizures, hypersensitivity reaction, visual disturbances, dizziness