Medications

The physician has ordered an injection of RhoGam for the postpartum client whose blood type is A negative but whose baby is O positive. To provide postpartum prophylaxis. RhoGam should be administered: A. Within 72 hours of delivery B. Within 1 week of delivery C. Within 2 weeks of delivery D. Within 1 month of delivery

Answer: A, within 72 hrs of delivery Rationale: To provide protection against antibody production. RhoGam should be given within 72 hours. The answers in B. C. and D are too late to provide antibody protection. RhoGam can also be given during pregnancy.

This drug is usually given parentally to enhance uterine contraction: A. Terbutaline B. Pitocin C. Magnesium sulfate D. Lidocaine

Answer: B, Pitocin

While the postpartum client is receiving heparin for thrombophlebitis, which of the following drugs would the nurse expect to administer if the client develops complications related to heparin therapy? A. Calcium gluconate B. Protamine sulfate C. Methylergonovine (Methergine) D. Nitrofurantoin (Macrodantin)

Answer: B, protamine sulfate Rationale: Protamine sulfate is a heparin antagonist given intravenously to counteract bleeding complications caused by heparin overdose.

A pregnant patient asks the nurse if she can take castor oil for her constipation. How should the nurse respond? A. "Yes, it produces no adverse effect." B. "No, it can initiate premature uterine contractions." C. "No, it can promote sodium retention." D. "No, it can lead to increased absorption of fat-soluble vitamins."

Answer: B. "No, it can initiate premature uterine contractions." Rationale: Castor oil can initiate premature uterine contractions in pregnant women. It also can produce other adverse effects, but it does not promote sodium retention. Castor oil is a harsh stimulant laxative that relieves constipation by forced bowel movements. Side effects may include nausea, stimulation of uterine activity, meconium-stained fluid, and amniotic fluid embolism.

Which of the following is a major side effect of butorphanol tartrate (Stadol)? A. Blurred vision B. Agitation C. Feelings of dysphoria D. Drowsiness

Answer: C, feelings of dysphoria Rationale: Feelings of dysphoria are a major side effect of Stardol. This med is used an analgesia during labor.

A nurse is preparing dinoprostone to a client to induce labor. Which of the following nursing intervention must be questioned? A. Have the client hold void before administration. B. Place the client on a side lying position for 30 to 60 minutes after the administration. C. Monitor maternal vital signs. D. Have the client void before administration.

Answer A: Have the client hold void before administration Rationale: Dinoprostone is a prostaglandin use in the induction of labor. It is administered vaginally so in order for the medication not to be contaminated with urine, the nurse should let the client void before administration.

For what common side effects of epidural anesthesia should the nurse watch? Select all that apply. A. Elevated maternal temperature B. Urinary retention C. Nausea D. Long-term back pain E. Local itching

Answer: A, elevated maternal temp B, urinary retention C, nausea E, local itching Rationale: These are all common side effects of epidural anesthesia. Pruritus may occur at any time during the epidural infusion. It usually appears first on the face, neck, or torso and is generally the result of the agent used in the epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.

A patient in labor is requesting pain medication. The nurse assess her labor status first, focusing on: (Select all that apply) A. The contraction pattern B. The amount of cervical ripening C. When labor began D. Whether the membranes are intact or ruptured E. The fetal presenting part

Answer: A, contraction pattern B, amount of cervical ripening E, fetal presenting part

The nurse knows that which of the following are advantages of spinal block? Select all that apply. A. Intense blockade of sympathetic fibers B. Relative ease of administration C. Maternal compartmentalization of the drug D. Immediate onset of anesthesia E. Larger drug volume

Answer: B, relative ease of administration C, maternal compartmentalization of drug D, immediate onset of anesthesia

Methylergonovine (Methergine) is prescribed to a patient who is having a postpartum bleeding. Prior giving the medication, the nurse contacts the physician who prescribed the medication if which of the following condition is documented in the patient's chart? A. Ischemic heart disease B. Diabetes Mellitus C. Acute Gastroenteritis D. Hypothyroidism

Answer: A, Ischemic heart disease Rationale: Methergine is a semi-synthetic ergot alkaloid used for the prevention and control of postpartum hemorrhage. Ergot alkaloids are contraindicated in patients with cardiovascular diseases such as ischemic heart disease, stroke, peripheral vascular disease, rheumatic heart disease.

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, Misoprostol is contraindicated in women attempting a VBAC Rationale: Prostaglandins are 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

A client had an epidural inserted 2 hours ago. It is functioning well, the client is stable, and labor is progressing. Which parts of the nurse's assessment have the highest priority? Select all that apply. A. Assess blood pressure every hour. B. Assess the pulse rate every hour. C. Palpate the bladder. D. Auscultate the lungs. E. Assess the reflexes.

Answer: A, assess BP every hour & C, palpate bladder Blood pressure should be monitored every 1 to 2 minutes for the first 10 minutes and then every 5 to 15 minutes until the block wears off because hypotension is the most common side effect of epidural anesthesia. Nursing care following an epidural block includes frequent assessment of the bladder to avoid bladder distention. Catheterization may be necessary, because most women are unable to void.

A pregnant woman who is having labor pains is receiving an opioid analgesic. Which of the following medications should be ready in case a respiratory depression occurs? A. Naloxone (Narcan) B. Oxycodone (Oxycontin) C. Meperidine hydrochloride (Demerol) D. Morphine sulfate

Answer: A, naloxone (Narcan) Rationale: Opioid analgesics are prescribed for to pregnant women who are experiencing moderate to severe labor pains. Respiratory depression may occur as a sign of opioid toxicity. Naloxone is an opioid antagonist, which reverses the effects of opioid toxicity such as respiratory depression.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures B. Reduce blood pressure C. Slow the process of labor D. Increase dieresis

Answer: A, prevent seizures

A nurse is checking the postpartum orders. The doctor has prescribed bed rest for 6-12 hours. The nurse knows this is an appropriate order if the client had which type of anesthesia? A. Spinal B. Pudendal C. General D. Epidural

Answer: A, spinal

Because cervical effacement and dilation are not progressing in a patient in labor, the doctor orders I.V. administration of oxytocin (Pitocin). Why should the nurse monitor the patient's fluid intake and output closely during oxytocin administration? A. Oxytocin causes water intoxication. B. Oxytocin causes excessive thirst. C. Oxytocin is toxic to the kidneys. D. Oxytocin has a diuretic effect.

Answer: A. Oxytocin causes water intoxication. Rationale: The nurse should monitor fluid intake and output because prolonged oxytocin infusion may cause severe water intoxication, leading to seizures, coma, and death. In addition, oxytocin may cause water intoxication via an antidiuretic hormone-like activity when administered in excessive doses with electrolyte-free solution.

When administering magnesium sulfate to a client with preeclampsia, the nurse understands that this drug is given to: A. Prevent seizures. B. Reduce blood pressure. C. Slow the process of labor. D. Increase diuresis.

Answer: A. Prevent seizures Rationale: The chemical makeup of magnesium is similar to that of calcium and, therefore, magnesium will act like calcium in the body. As a result, magnesium will block seizure activity in a hyper-stimulated neurologic system by interfering with signal transmission at the neuromuscular junction. Magnesium sulfate may attenuate BP by decreasing the vascular response to pressor substances, but it is not the primary indication.

The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is: A. Decreased urinary output B. Hypersomnolence C. Absence of knee jerk reflex D. Decreased respiratory rate

Answer: B, Hypersomnolence Rationale: hypersomnolence is an expected side effect, the other options are indicators of magnesium sulfate toxicity

A nurse is planning an educational seminar on medical vs. complementary and alternative methods of cervical ripening. The nurse teaches that the medical method uses: A. Blue/black cohosh herbs B. Misoprostol (Cytotec) C. Evening primrose oil D. Sexual intercourse

Answer: B, Misoprostol (Cytotec) Rationale: Misoprostol (Cytotec) is used in the medical model of care for cervical ripening, whereas blue/black cohosh herbs, primrose oil, and sexual intercourse are considered complementary and alternative methods.

Following a vaginal delivery in the hospital setting, the doctor routinely orders an oxytocin to be given to the mother parenterally. The oxytocin is usually given after the placenta has been delivered and not before because: A. Oxytocin will prevent bleeding B. Oxytocin can make the cervix close and thus trap the placenta inside C. Oxytocin will facilitate placental delivery D. Giving oxytocin will ensure complete delivery of the placenta

Answer: B, Oxytocin can make the cervix close and thus trap the placenta inside

A nurse is preparing to administer a Rubella vaccine to a client prior discharge home. Which of the following is not true regarding this vaccine? A. Pain, redness, swelling, or a lump is some of the adverse reaction B. Given intramuscularly in the lateral aspect of the middle third of the vastus lateralis muscle C. The need to use of contraception after immunization D. Contraindicated in a client with an allergy to duck eggs

Answer: B, given intramuscularly in lateral aspect of middle 1/3 of vastus lateralis muscle Rationale: Rubella Vaccine is administered subcutaneously prior hospital discharge to a nonimmune postpartum client. Option A: Common side effects on the injection site. Option C: The client should avoid pregnancy for 1 to 3 months after immunization with rubella vaccine. Option D: The possible presence of egg protein in the vaccine.

A laboring client has received an order for epidural anesthesia. In order to prevent the most common complication associated with this procedure, what would the nurse expect to do? A. Observe fetal heart rate variability B. Hydrate the vascular system with 500-1000 mL of intravenous fluids C. Place the client in the semi-Fowler's position D. Teach the client appropriate breathing techniques

Answer: B, hydrate w 500-1000mL IV fluids Rationale: The risk of hypotension can be minimized by hydrating the vascular system with 500-1000 mL of IV solution before the procedure and changing the woman's position and/or increasing the IV rate afterward. Usually Lactated Ringers Solution (LR)

A nurse is caring for a patient receiving oxytocin therapy suddenly is experiencing hypertonic contractions. Which of the following priority nursing actions should the nurse do? Select all that apply. A. The nurse leaves the client to ask for help B. Stop the oxytocin infusion C. Increase the flow rate of the intravenous additive solution D. Place the client in the supine position E. Administer oxygen at 8 to 10 liters per minute

Answer: B, stop the oxytocin infusion + C, increase flow rate of IV additive solution + E, administer oxygen at 8-10 liters per minute Rationale: The presence of hypertonic contractions indicates the need to initiate emergency measures. The oxytocin infusion must be stopped to reduce uterine stimulation, administering oxygen will promote increased fetal and maternal oxygenation. Option A: The nurse should stay with the client. Option D: Placing the client in a supine position will not promote an increase in placental oxygenation.

When preparing a teaching plan for a client who is to receive a rubella vaccine during the postpartum period, the nurse in charge should include which of the following? A. The vaccine prevents a future fetus from developing congenital anomalies. B. Pregnancy should be avoided for 3 months after the immunization. C. The client should avoid contact with children diagnosed with rubella. D. The injection will provide immunity against the 7-day measles.

Answer: B. Pregnancy should be avoided for 3 months after the immunization Rationale: After administration of rubella vaccine, the client should be instructed to avoid pregnancy for at least 3 months to prevent the possibility of the vaccine's toxic effects to the fetus. Option A: The role of the vaccine postpartum is to protect the mother against rubella in the future pregnancies as well as measles and mumps, since it is given together. Option C: Protection against measles, mumps, and rubella starts to develop around 2 weeks after having the MMR vaccine. Option D: One dose of MMR vaccine is 93% effective against measles, 78% effective against mumps, and 97% effective against rubella.

A nurse instructor is about to administer a vitamin K injection to a newborn. The student nurse asks the instructor regarding the purpose of the injection. The appropriate response would be: A. "The vitamin K provides active immunity." B. "The vitamin K will prevent the occurrence of hyperbilirubinemia." C. "The vitamin K will protect the newborn from bleeding." D. "The vitamin K will serve as protection against jaundice and anemia."

Answer: C, Vitamin K will protect newborn from bleeding Rationale: Vitamin K promotes the formation of clotting factors II, VII, IX & X in which the infants lack because of insufficient intestinal bacteria needed for synthesizing fat-soluble vitamin K. Option A: Vitamin K does not promote the development of immunity. Option B: Vitamin K does not prevent the occurrence of hyperbilirubinemia. Option D: Vitamin K doesn't prevent the newborn from having jaundice or anemia.

A client in preterm labor (32 weeks) who is dilated to 5cm has been given magnesium sulfate and the contractions have stopped. If the labor can be delayed for the next 2 days, which of the following medication does the nurse expect that will be prescribed? A. Fentanyl (Sublimaze) B. Sufentanil (Sufenta) C. Betamethasone (Celestone) D. Butorphanol tartrate (Stadol)

Answer: C, betamethasone (Celestone) Rationale: Glucocorticoids such as betamethasone and dexamethasone are being used to increase the production of surfactant to aid in fetal lung maturation. It is being given to patients who are in preterm labor at 28-32 weeks of gestation if the labor can be stopped for 2 days. Option A, B, and D are opioid analgesic.

Prior giving of Methylergonovine, what is the priority assessment for the nurse to check which of the following? A. Deep tendon reflexes B. Urine output C. Blood pressure D. Vaginal bleeding

Answer: C, blood pressure Rationale: Methylergonovine causes uterine contractions and can elevate the blood pressure, so the priority assessment for the nurse to take is to check the blood pressure first. Options A, B, and D are part of postpartum assessment but does not specifically relate to the administration of the medication.

A client elects to have epidural anesthesia to relieve the discomfort of labor. Following the initiation of epidural anesthesia. the nurse should give priority to: A. Checking for cervical dilation B. Placing the client in a supine position C. Checking the client's blood pressure D. Obtaining a fetal heart rate

Answer: C, check client's BP Rationale: Following epidural anesthesia. the client should be checked for hypotension and signs of shock every 5 minutes for 15 minutes. The client can be checked for cervical dilation later after she is stable. The client should not be positioned supine because the anesthesia can move above the respiratory center and the client can stop breathing. Fetal heart tones should be assessed after the blood pressure is checked.

Rho(D) immune globulin (RhoGAM) is given to a pregnant woman after delivery and the nurse is giving information to the patient about the indication of the medication. The nurse determines that the patient understands the purpose of the medication if the patient tells that it will protect her baby from which of the following? A. Developing German Measles B. Developing Pernicious anemia C. Developing Rh incompatibility D. Having an RH+ blood

Answer: C, developing Rh incompatibility Rationale: Rh incompatibility can develop when a Rh-negative mother becomes sensitized to the RH antigen. Sensitization may occur when a Rh-negative woman becomes pregnant with a fetus who is Rh positive. Blood cells from the baby may cross the maternal bloodstream, which can happen during pregnancy, labor, and delivery, causing the mother's immune system to form antibodies, against Rh-positive blood. Administration of the Rhogam prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen. Options A and B are not related to the Rh incompatibility. Option D is not indicated for the administration of Rhogam.

A client dilated to 5 cm has just received an epidural for pain. She complains of feeling lightheaded and dizzy within 10 minutes after the procedure. Her blood pressure was 120/80 before the procedure and is now 80/52. In addition to the bolus of fluids she has been given, which medication is preferred to increase her BP? A. Epinephrine B. Terbutaline C. Ephedrine D. Epifoam

Answer: C, ephedrine Rationale: this is the medicine of choice to increase maternal blood pressure

Which of the following laboratory test must be monitored for pregnant patients receiving dexamethasone? A. Red blood cell count B. Serum Calcium C. Random blood sugar D. Uric acid

Answer: C, random blood sugar Rationale: Elevation of blood glucose level is expected for patients receiving corticosteroid therapy such as dexamethasone so a routine check on the sugar level must be monitor. Option A: Instead of RBC count, WBC count must be monitor for any signs of infection because corticosteroid suppresses the immune system. Options B and D are not related to the use of dexamethasone.

A pregnant client is receiving magnesium sulfate therapy for the control of preeclampsia. A nurse discover that the client is encountering toxicity from the medication in which of the following assessment? A. Urine output of 35 ml/hr B. The presence of deep tendon reflex C. Respirations of 10 breaths per minute D. Serum magnesium level of 7 mEq/L

Answer: C, respirations of 1 bpm Rationale: Magnesium sulfate is a central nervous system depressant and anticonvulsant. It can cause smooth muscle relaxation. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, decreased urine output, loss of deep tendon reflexes, hypotension and a decrease maternal and fetal heart rate Option A: Urine output should be maintained at > 30ml/hr Option B: Deep tendon reflexes must be present Option D: Normal range for magnesium is between 4-7 mEq/L

Two hours after an epidural infusion has begun, a client complains of itching on her face and neck. What should the nurse do? A. Remove the epidural catheter and apply a Band-Aid to the injection site. B. Offer the client a cool cloth and let her know the itching is temporary. C. Recognize that this is a common side effect, and follow protocol for administration of Benadryl. D. Call the anesthesia care provider to re-dose the epidural catheter.

Answer: C, this is a common side effect, follow protocol administration of Benadryl Rationale: Itching is a side effect of the medication used for an epidural infusion. Benadryl, an antihistamine, can be administered to manage pruritus.

During labor induction with oxytocin, the nurse knows that relaxation of vascular smooth muscle can cause: A. Hypertension, premature atrial contractions B. Hyperglycemia, premature ventricular contractions C. Hyperglycemia, hypertension D. Hypotension and flushing

Answer: D, Hypotension and flushing Rationale: Relaxation of vascular smooth muscle will cause vasodilation leading to hypotension and flushing

The nurse should realize that the most common and potentially harmful maternal complication of epidural anesthesia is: A. severe postpartum headache B. limited perception of bladder fullness C. increase in respiratory rate D. hypotension

Answer: D, hypotension Headache is not a side effect since the spinal fluid is not disturbed by this anesthetic because it would be with a low spinal (saddle block) anesthetic. Limited perception of bladder fullness is an effect of epidural anesthesia but is not the most harmful. Respiratory depression is a potentially serious complication. Epidural anesthesia can lead to vasodilation and a drop in blood pressure that could interfere with adequate placental perfusion. The woman must be well hydrated before and during epidural anesthesia to prevent this problem and maintain an adequate blood pressure.

A patient is having contractions that last 20-30 seconds and occur every 8-20 minutes. The patient is requesting something to help relieve the discomfort of contractions. The nurse should suggest: A. That a mild analgesic be administered. B. An epidural. C. A local anesthetic block. D. Nonpharmacologic methods of pain relief.

Answer: D, nonpharmacologic methods of pain relief

In evaluating the effectiveness of IV Pitocin for a client with secondary dystocia. the nurse should expect: A. A painless delivery B. Cervical effacement C. Infrequent contractions D. Progressive cervical dilation

Answer: D, progressive cervical dilation The expected effect of Pitocin is cervical dilation. Pitocin causes more intense contractions. which can increase the pain. making answer A incorrect. Cervical effacement is caused by pressure on the presenting part. so answer B is incorrect. Answer C is opposite the action of Pitocin.

Prior to receiving lumbar epidural anesthesia, the nurse would anticipate placing the laboring client in which position? A. On her right side in the center of the bed with her back curved B. Lying prone with a pillow under her chest C. On her left side with the bottom leg straight and the top leg slightly flexed D. Sitting on the edge of the bed

Answer: D, sitting on edge of bed Rationale: The woman is positioned on her left or right side, at the edge of the bed with the assistance of the nurse, with her legs slightly flexed, or she is asked to sit on the edge of the bed.

A nurse is assigned to a patient who is receiving Oxytocin (Pitocin) to induce labor. The nurse terminates the oxycontin infusion if which of the following is noted on the assessment of the client? A. Early decelerations of the fetal heart rate B. Fatigue C. Nausea D. Uterine hyperstimulation

Answer: D, uterine hyperstimulation Rationale: Oxytocin is used to induce labor by stimulating uterine contraction. Oxytocin infusion must be discontinued if any signs of uterine stimulation are present. Option A: Early decels of the FHR are a reassuring sign and does not indicate fetal distress. Options B and C are probably caused by the labor experience itself.

A primigravida in active labor is about 9 days post-term. The client desires a bilateral pudendal block anesthesia before delivery. After the nurse explains this type of anesthesia to the client, which of the following locations identified by the client as the area of relief would indicate to the nurse that the teaching was effective? A. Back B. Abdomen C. Fundus D. Perineum

Answer: D. Perineum Rationale: A bilateral pudendal block is used for vaginal deliveries to relieve pain primarily in the perineum and vagina. Pudendal block anesthesia is adequate for episiotomy and its repair.