Mg Sulfate, Betamethasone, Indomethacin, Nifedipine, Oxytocin, Terbutaline, Insulin & Heparin

After teaching a group of nursing students about tocolytic therapy, the instructor determines that the teaching was successful when they identify which drug as being used for tocolysis? (Select all that apply.) (3) A) Nifedipine B) Terbutaline C) Dinoprostone D) Misoprostol E) Indomethacin

A, B, E Feedback: Medications most commonly used for tocolysis include magnesium sulfate (which reduces the muscle's ability to contract), terbutaline (Brethine, a beta-adrenergic), indomethacin (Indocin, a prostaglandin synthetase inhibitor), and nifedipine (Procardia, a calcium channel blocker). These drugs are used "off label": this means they are effective for this purpose but have not been officially tested and developed for this purpose by the FDA. Dinoprostone and misoprostol are used to ripen the cervix.

It is confirmed that a 14-week fetus has died. The patient has an unfavorable cervix. Which approaches to deliver the fetus should be reviewed with the patient? Select all that apply. (4) 1. Oxytocin 2. Misoprostol 3. Prostaglandins 4. Laminaria tent 5. Cesarean section

Answer: 1, 2, 3, 4 Explanation: Women with an unfavorable cervix may be given vaginal prostaglandin agents, misoprostol, or laminaria tents. Women whose gestations are less than 16 gestational weeks may have a laminaria tent inserted into the cervix before a dilatation and extraction procedure. Women less than 28 weeks' gestation are typically given prostaglandin E2 vaginal suppositories (10-20 mg q 4-6 h), misoprostol 400 mcg vaginally or orally every 4 to 6 hours, and/or oxytocin until spontaneous labor occurs. Cesarean section is not a method identified to deliver the dead fetus.

A 28-year-old woman has been an insulin-dependent diabetic for 10 years. At 36 weeks' gestation, she has an amniocentesis. A lecithin/sphingomyelin (L/S) ratio test is performed on the sample of her amniotic fluid. Because she is a diabetic, what would an obtained 2:1 ratio indicate for the fetus? A) The fetus may or may not have immature lungs. B) The amniotic fluid is contaminated. C) The fetus has a neural tube defect. D) There is blood in the amniotic fluid.

Answer: A Explanation: A) Infants of diabetic mothers (IDMs) have a high incidence of false-positive results (i.e., the L/S ratio is thought to indicate lung maturity, but after birth the baby develops RDS). B) Meconium contaminates the amniotic fluid and does not indicate fetal lung maturity. C) Neural tube defects are screened with the maternal serum alpha-fetoprotein test, and diagnosed with ultrasound. D) LBCs testing, not a lecithin/sphingomyelin (L/S) ratio test, tests diabetic women and can be performed when there is blood in the amniotic fluid.

The nurse would expect a physician to prescribe which medication to a postpartum client with heavy bleeding and a boggy uterus? A) Methylergonovine maleate (Methergine) B) Rh immune globulin (RhoGAM) C) Terbutaline (Brethine) D) Docusate (Colace)

Answer: A Explanation: A) Methylergonovine maleate is the drug used for the prevention and control of postpartum hemorrhage. B) RhoGAM is a medicine given by intramuscular injection that is used to prevent the immunological condition known as Rh disease (or hemolytic disease of the newborn). C) Terbutaline (Brethine) is a β2-adrenergic receptor agonist used as a "reliever" inhaler in the management of asthma. D) Docusate is a stool softener

The nurse administered oxytocin 20 units at the time of placental delivery. Why was this primarily done? A) To contract the uterus and minimize bleeding B) To decrease breast milk production C) To decrease maternal blood pressure D) To increase maternal blood pressure

Answer: A Explanation: A) Oxytocin is given to contract the uterus and minimize bleeding. B) Oxytocin does not have an effect on breast milk production. C) Oxytocin does not have an effect on maternal blood pressure. D) Oxytocin does not have an effect on maternal blood pressure

A woman has been having contractions since 4 a.m. At 8 a.m., her cervix is dilated to 5 cm. Contractions are frequent, and mild to moderate in intensity. Cephalopelvic disproportion (CPD) has been ruled out. After giving the mother some sedation so she can rest, what would the nurse anticipate preparing for? A) Oxytocin induction of labor B) Amnioinfusion C) Increased intravenous infusion D) Cesarean section

Answer: A Explanation: A) Oxytocin is the drug of choice for labor augmentation or labor induction and may be administered as needed for hypotonic labor patterns. B) Amnioinfusion would not change the ineffective labor pattern. C) Increasing the IV infusion would not change the ineffective labor pattern. D) Because CPD has been ruled out, a cesarean section is not anticipated

A variety of drugs are used either alone or in combination to provide relief of postpartum pain. Which of the following would be an option for pain relief? A) Nonsteroidal anti-inflammatory agents B) Proquad C) Methergine D) Intravenous oxytocin

Answer: A Explanation: A) A variety of drugs are used alone or in combination to provide relief of postpartum pain. An option would include nonsteroidal anti-inflammatory agents such as ibuprofen and ketorolac. B) Proquad is a measles, mumps, rubella, and varicella live virus vaccine. C) Methergine is prescribed to promote uterine contractions. D) Intravenous oxytocin (Pitocin) remains the first-line drug for excessive bleeding related to postpartum uterine atony.

A client is experiencing excessive bleeding immediately after the birth of her newborn. After speeding up the IV fluids containing oxytocin, with no noticeable decrease in the bleeding, the nurse should anticipate the physician requesting which medications? Select all that apply. (2) A) Methergine B) Coumadin C) Misoprostol D) Serotonin reuptake inhibitors (SSRIs) E) Nonsteroidal anti-inflammatory drugs

Answer: A, C Explanation: A) Methergine is commonly used orally for postpartum hemorrhage. B) Coumadin (warfarin) is an anticoagulant and is not used for postpartum hemorrhage. C) Misoprostol is commonly used rectally for postpartum hemorrhage. D) Serotonin reuptake inhibitors (SSRIs) are antidepressants and would not be used for postpartum hemorrhage. E) Nonsteroidal anti-inflammatory drugs increase anticoagulant activity and would not be used for postpartum hemorrhage.

A client is at 12 weeks' gestation with her first baby. She has cardiac disease, class III. She states that she had been taking sodium warfarin (Coumadin), but her physician changed her to heparin. She asks the nurse why this was done. What should the nurse's response be? A) "Heparin is used when coagulation problems are resolved." B) "Heparin is safer because it does not cross the placenta." C) "They are the same drug, but heparin is less expensive." D) "Coumadin interferes with iron absorption in the intestines."

Answer: B Explanation: A) Heparin is used when coagulation problems develop. B) Heparin is safest for the client to take because it does not cross the placental barrier. C) Heparin does not cost less than Coumadin. D) Coumadin does not interfere with iron absorption in the intestines.

The client presents for cervical ripening in anticipation of labor induction tomorrow. What should the nurse include in her plan of care for this client? A) Apply an internal fetal monitor. B) Monitor the client using electronic fetal monitoring. C) Withhold oral intake and start intravenous fluids. D) Place the client in an upright, sitting position.

Answer: B Explanation: A) An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred and the membranes are ruptured. B) The client should be monitored using electronic fetal monitoring for at least 30 minutes and up to 2 hours after placement to assess the contraction pattern and the fetal status. C) Until labor begins, there is no rationale for withholding oral intake. D) The client is placed in a reclining position and bed rest is maintained to prevent the medication from leaking from the vagina.

What is required for any woman receiving oxytocin (Pitocin)? A) CPR B) Continuous electronic fetal monitoring C) Administering oxygen by mask D) Nonstress test

Answer: B Explanation: A) CPR is not required for a woman receiving oxytocin. B) Continuous electronic fetal monitoring (EFM) is required for any woman receiving oxytocin (Pitocin). C) Administering oxygen by mask is not required for a woman receiving oxytocin. D) Nonstress test is not required for a woman receiving oxytocin.

A woman has been admitted for an external version. She has completed an ultrasound exam and is attached to the fetal monitor. Prior to the procedure, why will terbutaline be administered? A) To provide analgesia B) To relax the uterus C) To induce labor D) To prevent hemorrhage

Answer: B Explanation: A) Terbutaline has no analgesic effect. B) Terbutaline is administered to achieve uterine relaxation. C) Terbutaline does not induce labor. D) Terbutaline does not prevent hemorrhage.

Under which circumstances would the nurse remove prostaglandin from the client's cervix? Select all that apply. (3) A) Contractions every 5 minutes B) Nausea and vomiting C) Uterine tachysystole D) Cardiac tachysystole E) Baseline fetal heart rate of 140-148

Answer: B, C, D Explanation: A) Contractions every 5 minutes are consistent with the plan of induction. B) A reason to remove prostaglandin from a client's cervix is the presence of nausea and vomiting. C) A reason to remove prostaglandin from a client's cervix is uterine tachysystole. D) A reason to remove prostaglandin from a client's cervix is cardiac tachysystole. E) This is a good heart rate and would not warrant removing the prostaglandin.

Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important? A) Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours. B) Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour. C) Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec). D) Prepare to induce labor after administering a tap water enema

Answer: C Explanation: A) 100 mcg every 2 hours is too much medication administered too frequently. B) The client must remain recumbent for 2 hours after administration of dinoprostone (Prepidil) vaginal gel, during which time she is continuously monitored. C) Pitocin should not administered less than 4 hours after the last Cytotec dose. D) Enemas are not routinely used in labor. This order is not expected

Induction of labor is planned for a 31-year-old client at 39 weeks due to insulin-dependent diabetes. Which nursing action is most important? A) Administer 100 mcg of misoprostol (Cytotec) vaginally every 2 hours. B) Place dinoprostone (Prepidil) vaginal gel and ambulate client for 1 hour. C) Begin Pitocin (oxytocin) 4 hours after 50 mcg misoprostol (Cytotec). D) Prepare to induce labor after administering a tap water enema.

Answer: C Explanation: A) 100 mcg every 2 hours is too much medication administered too frequently. B) The client must remain recumbent for 2 hours after administration of dinoprostone (Prepidil) vaginal gel, during which time she is continuously monitored. C) Pitocin should not administered less than 4 hours after the last Cytotec dose. D) Enemas are not routinely used in labor. This order is not expected.

The charge nurse is assessing several postpartum clients. Which client has the greatest risk for postpartum hemorrhage? A) The client who was overdue and delivered vaginally B) The client who delivered by scheduled cesarean delivery C) The client who had oxytocin augmentation of labor D) The client who delivered vaginally at 36 weeks

Answer: C Explanation: A) The client who was overdue and delivered vaginally has a lower risk for postpartum hemorrhage than would another client. B) The client who delivered by scheduled cesarean delivery has a lower risk for postpartum hemorrhage than would another client. C) Uterine atony is a cause of postpartal hemorrhage. A contributing factor to uterine atony is oxytocin augmentation of labor. D) The client who delivered vaginally at 36 weeks has a lower risk for postpartum hemorrhage than would another client.

A woman is experiencing preterm labor. The client asks why she is on betamethasone. Which is the nurse's best response? A) "This medication will halt the labor process until the baby is more mature." B) "This medication will relax the smooth muscles in the infant's lungs so the baby can breathe." C) "This medication is effective in stimulating lung development in the preterm infant." D) "This medication is an antibiotic that will treat your urinary tract infection, which caused preterm labor."

Answer: C Explanation: A) This medication has no effect on the labor process or on the smooth muscles in the lungs. B) This medication has no effect on the labor process or on the smooth muscles in the lungs. C) Betamethasone or dexamethasone is often administered to the woman whose fetus has an immature lung profile to promote fetal lung maturation. D) This medication is not an antibiotic, and therefore will not help resolve a urinary tract infection.

After inserting prostaglandin gel for cervical ripening, what should the nurse do? A) Apply an internal fetal monitor. B) Insert an indwelling catheter. C) Withhold oral intake and start intravenous fluids. D) Place the client in a supine position with a right hip wedge

Answer: D Explanation: A) An internal fetal monitor cannot be applied until adequate cervical dilatation has occurred. B) The client should void on her own and not need a catheter. C) Until labor begins, there is no rationale for withholding all intake. D) After the gel, intravaginal insert, or tablet is inserted, the woman is instructed to remain lying down with a rolled blanket or hip wedge under her right hip to tip the uterus slightly to the left for the first 30 to 60 minutes to maintain the cervical ripening agent in place.

A woman with preterm labor is receiving magnesium sulfate. Which finding would require the nurse to intervene immediately? A) Respiratory rate of 16 breaths per minute B) Diminished deep tendon reflexes C) Urine output of 45 mL/hour D) Alert level of consciousness

B Feedback: Diminished deep tendon reflexes suggest magnesium toxicity, which requires immediate intervention. Additional signs of magnesium toxicity include a respiratory rate less than12 breaths/minute, urine output less than 30 mL/hour, and a decreased level of consciousness.

A nurse is developing a plan of care for a woman who is at risk for thromboembolism. Which of the following would the nurse include as the most cost-effective method for prevention? A) Prophylactic heparin administration B) Compression stocking C) Early ambulation D) Warm compresses

C Feedback: Although compression stockings and prophylactic heparin administration may be appropriate, the most cost-effective preventive method is early ambulation. It is also the easiest method. Warm compresses are used to treat superficial venous thrombosis.

pregnant client undergoing labor induction is receiving an oxytocin infusion. Which of the following findings would require immediate intervention? A) Fetal heart rate of 150 beats/minute B) Contractions every 2 minutes, lasting 45 seconds C) Uterine resting tone of 14 mm Hg D) Urine output of 20 mL/hour

D. Urine output of 20 mL/hour Oxytocin can lead to water intoxication. Therefore, a urine output of 20 mL/hour is below acceptable limits of 30 mL/hour and requires intervention. FHR of 150 beats/minute is within the accepted range of 120 to 160 beats/minute. Contractions should occur every 2 to 3 minutes, lasting 40 to 60 seconds. A uterine resting tone greater than 20 mm Hg would require intervention.