NCLEX - Pharmacology - Reproductive / Maternity / Newborn
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.
Correct Answer: 3 Rationale: Betamethasone, a steroidal antiinflammatory, increases the surfactant level and promotes lung maturation, thereby reducing the risk of respiratory distress syndrome in the newborn infant. Surfactant production does not become stable until after 32 weeks of gestation, and if adequate amounts of lung surfactant are not present, respiratory distress and death of the newborn infant could result. Delivery should be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs to mature. The other options are incorrect.
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.
Correct Answer: 3 Rationale: The antidote for magnesium sulfate is calcium gluconate. This medication should be available if the client experiences magnesium toxicity. The respiratory rate and absence of deep tendon reflexes indicate magnesium toxicity and not the need for an increase in the rate of the medication. The client is not exhibiting signs and symptoms of preeclampsia, which might necessitate seizure precautions. There are no data to indicate that this client is experiencing a precipitous labor.
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.
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
Correct Answer: 1,4,5 Rationale: Magnesium sulfate is a central nervous system depressant and relaxes smooth muscle, including the uterus. It is used to halt preterm labor contractions and is used for preeclamptic clients to prevent seizures. Adverse effects include flushing, depressed respirations, depressed deep tendon reflexes, hypotension, extreme muscle weakness, decreased urine output, pulmonary edema, and elevated serum magnesium levels.
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
Correct Answer: 2 Rationale: Betamethasone, a glucocorticoid, is given to increase the production of surfactant to stimulate fetal lung maturation. It is administered to clients in preterm labor at 28 to 32 weeks of gestation if the labor can be inhibited for 48 hours. Nalbuphine is an opioid analgesic. Rho(D) immune globulin is given to Rh-negative clients to prevent sensitization. Dinoprostone vaginal insert is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.
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.
Correct Answer: 2 Rationale: For a client with preeclampsia, the goal of care is directed at preventing eclampsia (seizures). Scotomas are areas of complete or partial blindness. Visual disturbances, such as scotomas, often precede an eclamptic seizure. Ankle clonus indicates hyperreflexia and may precede the onset of eclampsia. Magnesium sulfate is an anticonvulsant, not an antihypertensive agent. Although a decrease in blood pressure may be noted initially, this effect is usually transient.
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."
Correct Answer: 2 Rationale: Magnesium sulfate produces flushing and sweating because of decreased peripheral blood pressure. It decreases the frequency and duration of uterine contractions and decreases central nervous system activity, acting as an anticonvulsant. Magnesium sulfate decreases (not increases) acetylcholine, blocking neuromuscular transmission.
Methylergonovine is prescribed for a woman to treat postpartum hemorrhage. Before administration of methylergonovine, what is the priority assessment? 1.Uterine tone 2.Blood pressure 3.Amount of lochia 4.Deep tendon reflexes
Correct Answer: 2 Rationale: Methylergonovine, an ergot alkaloid, is used to prevent or control postpartum hemorrhage by contracting the uterus. Methylergonovine causes continuous uterine contractions and may elevate the blood pressure. A priority assessment before the administration of the medication is to check the blood pressure. The health care provider needs to be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, blood pressure is related specifically to the administration of this medication.
The nurse is preparing to administer exogenous surfactant to a premature infant who has respiratory distress syndrome. The nurse prepares to administer the medication by which route? 1.Intradermal 2.Intratracheal 3.Subcutaneous 4.Intramuscular
Correct Answer: 2 Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and the inability to produce surfactant, resulting in hypoxia and acidosis. It is common in premature infants and may be due to lung immaturity as a result of surfactant deficiency. The mainstay of treatment is the administration of exogenous surfactant, which is administered by the intratracheal route. Options 1, 3, and 4 are not routes of administration for this medication.
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."
Correct Answer: 2 Rationale: Vitamin K is given to the newborn to prevent clotting abnormalities. Vitamin K is usually produced by bacteria in the gastrointestinal tract, which is sterile in the newborn. The other options are incorrect reasons for administering this medication to a newborn.
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 mmol/L)
Correct Answer: 2,4 Rationale: Magnesium toxicity can occur from magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, and a sudden decline in fetal heart rate and maternal heart rate and blood pressure. Respiratory rate below 12 breaths per minute is a sign of toxicity. Urine output should be at least 25 to 30 mL per hour. Proteinuria of 3+ is an expected finding in a client with preeclampsia. Presence of deep tendon reflexes is a normal and expected finding. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L (2 to 3.75 mmol/L).
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 (2.5 mmol/L)
Correct Answer: 3 Rationale: Magnesium toxicity is a risk associated with magnesium sulfate therapy. Signs of magnesium toxicity relate to central nervous system (CNS) depression and include respiratory depression, loss of deep tendon reflexes, and sudden drop in fetal heart rate and/or maternal heart rate and blood pressure. Magnesium is excreted through the kidneys. If renal impairment is present, magnesium toxicity can develop very quickly. Therapeutic serum levels of magnesium are 4 to 7 mEq/L (2 to 3.5 mmol/L).
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
Correct Answer: 3 Rationale: Methylergonovine is an ergot alkaloid that is given following delivery to treat postpartum hemorrhage. It acts by vasoconstricting arterioles and directly stimulating uterine muscle contractions. Blood pressure may increase, but this is not the intended therapeutic effect. Decreased pulse rate and increased urine output are unrelated to the effects of this medication.
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
Correct Answer: 3 Rationale: Methylergonovine, an oxytocic, is an agent that is used to prevent or control postpartum hemorrhage by contracting the uterus. The immediate dose usually is given intramuscularly; if additional medication is needed, it is given by mouth. No relationship exists between the action of this medication and lochial drainage. This medication may elevate the blood pressure and increase the strength and frequency of contractions. A priority assessment component before the administration of methylergonovine is blood pressure.
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.
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
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.
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
Correct Answer: 4 Rationale: Betamethasone is classified as an antiinflammatory and corticosteroid. It increases the surfactant level and lung maturity in the fetus, which reduces the incidence of respiratory distress syndrome. Delivery must be delayed for at least 48 hours after administration of betamethasone to allow time for the lungs of the fetus to mature. Betamethasone is not related to treatment for Chlamydia, hypoglycemia, or hyperbilirubinemia.
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."
Correct Answer: 4 Rationale: It is important that pregnant clients receive iron supplements because of the extra demands placed on maternal circulation by the fetus. Although the fetus does need iron, option 1 is not the best response considering the other options presented. Option 2 is an inappropriate and incorrect response because the iron does not have to be discontinued. Seeing the health care provider immediately is unnecessary at this time.
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.
Correct Answer: 4 Rationale: Magnesium toxicity can occur as a result of magnesium sulfate therapy. Signs of magnesium sulfate toxicity relate to the central nervous system depressant effects of the medication and include respiratory depression, loss of deep tendon reflexes, sudden decrease in fetal heart rate or maternal heart rate or both, and sudden drop in blood pressure. An absence of reflexes indicates magnesium excess and toxicity. The infusion rate therefore would not be increased. Hyperreflexia indicates increased cerebral edema.
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
Correct Answer: 4 Rationale: Rh incompatibility can occur when an Rh-negative mother becomes sensitized to the Rh antigen. Sensitization may develop when an Rh-negative woman becomes pregnant with a fetus who is Rh positive. During pregnancy and at delivery, some of the fetus's Rh-positive blood can enter the maternal circulation, causing the mother's immune system to form antibodies against Rh-positive blood. Administration of Rho(D) immune globulin prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.
An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily accessible should respiratory depression occur? 1.Naloxone 2.Morphine sulfate 3.Betamethasone 4.Hydromorphone hydrochloride
Correct Answer: 1 Rationale: Opioid analgesics may be prescribed to relieve moderate to severe pain associated with labor. Opioid toxicity can occur and cause respiratory depression. Naloxone is an opioid antagonist, which reverses the effects of opioids and is given for respiratory depression. Morphine sulfate and hydromorphone hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.
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)
Correct Answer: 3 Rationale: The therapeutic range for magnesium sulfate is 4 to 7 mEq/L (2 to 3.5 mmol/L); 1 mEq/L (0.5 mmol/L) and 3 mEq/L (1.5 mmol/L) are low values and 10 mEq/L (5 mmol/L) is an elevated value.
Methylergonovine is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse should contact 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
Correct Answer: 4 Rationale: Methylergonovine is an ergot alkaloid used to treat postpartum hemorrhage. Ergot alkaloids are contraindicated in clients with significant cardiovascular disease, peripheral vascular disease, hypertension, preeclampsia, or eclampsia. These conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. Options 1, 2, and 3 are not contraindications related to the use of ergot alkaloids.
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.
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
Correct Answer: 4 Rationale: Methylergonovine is an ergot alkaloid used for postpartum hemorrhage. It stimulates contraction of the uterus and causes arterial vasoconstriction. Ergot alkaloids are avoided in women with significant cardiovascular disease, peripheral disease, hypertension, eclampsia, or preeclampsia. Such conditions are worsened by the vasoconstrictive effects of the ergot alkaloids. The nurse should assess the woman's blood pressure before administering the medication and should follow agency protocols regarding withholding of the medication. Lochial discharge, urine output, and temperature are items that are assessed in the postpartum period, but they are unrelated to the use of this medication.
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
Correct Answer: 4 Rationale: Respiratory distress syndrome is a serious lung disorder caused by immaturity and inability to produce surfactant, resulting in hypoxia and acidosis. The aim of therapy in respiratory distress syndrome is to support the disease until it runs its course, with the subsequent development of surfactant. The infant may benefit from surfactant replacement therapy. In surfactant replacement, an exogenous surfactant preparation is instilled into the lungs through an endotracheal tube. All other options identify incorrect methods of administering surfactant.
The nurse 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 about administration of the eye medication? 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 hour after delivery." 4."I will instill the eye ointment into each of the newborn's conjunctival sacs."
Correct Answer: 1 Rationale: Eye prophylaxis protects the newborn against Neisseria gonorrhoeae and Chlamydia trachomatis. The eyes are not flushed after instillation of the medication because the flush would wash away the administered medication. Options 2, 3, and 4 are correct statements regarding the procedure for administering eye medication to the newborn.
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
Correct Answer: 1 Rationale: Signs of magnesium toxicity include central nervous system depression. The respiratory system will fail with the absence of deep tendon reflexes if this condition is not corrected. The client should maintain a respiratory rate at or greater than 16 breaths per minute (or per agency protocol), maintain the presence of deep tendon reflexes, and maintain a urinary output greater than 30 mL/hour. A decrease in blood pressure is a positive finding because preeclampsia is accompanied by hypertension.
