Maternity and Newborn Medication (Chap 35)

Question 1

Tocolytics

Answer 1

Tocolytics are medications that produce uterine relaxation and suppress
uterine activity in an attempt to halt uterine contractions and prevent preterm birth

Question 2

Tocolytic medication Indomethacin

Answer 2

Indomethacin (Indocin)

relaxes uterine smooth muscle

Question 3

Tocolytic medication: Magnesium sulfate

Answer 3

central nervous system depressant

• relaxes smooth muscle, including the uterus
• used to halt preterm labour contraction
• also used for preeclamptic clients to prevent seizures

Question 4

Tocolytic medication: Nifedipine

Answer 4

Nifedipine (procardia, adalat, nifedical)

calcium channel blocker, relaxes smooth muscle including the uterus by blocking calcium entry

Question 5

Tocolytic medication: Terbutaline

Answer 5

adrenergic agonist

- relaxes smooth muscle, inhibiting uterine activity and causes brocholilation

Question 6

What is the antidote to magnesium sulfate?

Answer 6

Calcium Gluconate

Question 7

True or False

Magnesium Sulfate is contraindicated for clients that have kidney disease?

Answer 7

TRUE

Question 8

What is the target range for Magnesium Sulfate?

Answer 8

4-7.5 mEq/L

Question 9

What would be given to a client in preterm labor between 28 and 32 weeks’ gestation whose labor
can be inhibited for 48 hours without jeopardizing the mother or fetus

Answer 9

Betamethasome (Celestone) and Dexamethasone

It is a corticosteroids that increase the production of surfactant to accelerate fetal lung maturity and reduce the incidence or severity of respiratory distress
syndrome

Question 10

What type of medication during pregnancy can produce withdrawal symptoms in the newborn?

Answer 10

Opioid Analgesic

Question 11

What are some symptoms of newborn withdrawn?

Answer 11

irritability, excessive crying, tremors, hyperactive refleces, fever, vomiting, diarrhea, yawning, sneezing and seizures

Question 12

What is the antidote for opioids?

Answer 12

Naloxone (Narcan)

Question 13

Name some opioid analgesic medication given to women for pain during labour?

Answer 13

Meperidine Hydrochloride (Demerol)
Hydromorphone Hydrochloride (Dilaudid)

Question 14

Why wouldn’t you give opioid medication to a women that is in labour?

Answer 14

it can slow the labour process and if the medication is not adequately removed from the fetal circulation, respiratory depression can occur

Question 15

What types of medication ripen the cervix and make it softer causing it to begin to dilate and efface?

Answer 15

Prostaglandins

- they stimulate uterine contractions and are administered vaginally

Question 16

Name 2 prostaglandin medications:

Answer 16

Misoprostol (Cytotec)

Dinoprostone (Cervidil)

Question 17

How many hours after prostaglandin therapy can you administer a uterine stimulant? (Oxytocin/Pitocin)

Answer 17

6-12 after the discontinuation of prostaglandin therapy

Question 18

What medication stimulates the smooth muscles of the uterus and increases the force, frequency and duration of uterine contractions?

Answer 18

Oxytocin (Pitocin)

Question 19

Oxytocin also promotes __________.

Answer 19

milk letdown

Question 20

What medication:

1. Induces or augments labor
2. Controls postpartum bleeding
3. Promotes milk letdown and facilitates breast-feeding (intranasal route)
4. Manages an incomplete abortion

Answer 20

Oxytocin (Pitocin)

Question 21

Rh0(D) Immune Globulin (RhoGAM, WinRho) is given to prevent antibody formation is most successful if the medication is given at _____ weeks and again within _____ hours after delivery

Answer 21

28 weeks

72 hours after delivery

Question 22

What is Phytonadione?

Answer 22

Vitamine K

- newborns are deficient in vitamin K for the first 5-8 days of life because of the lack of intestinal bacteria

Question 23

The nurse is monitoring a client who is receiving oxytocin (Pitocin) to induce
labor. Which assessment finding would cause the nurse to immediately
discontinue the oxytocin infusion?
1. Fatigue
2. Drowsiness
3. Uterine hyperstimulation
4. Early decelerations of the fetal heart rate

Answer 23

3. Uterine hyperstimulation

Oxytocin stimulates uterine contractions and is a common pharmacological method to induce labor.
High-dose protocols have been associated with more uterine hyperstimulation and more cesarean births related to
fetal stress. 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. Adverse effects associated with
administration of the medication are hyperstimulation of uterine contractions and nonreassuring fetal heart rate
patterns. Oxytocin infusion must be stopped when any signs of uterine hyperstimulation are present. 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.

Question 24

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 finding is noted on assessment?
1. Proteinuria of 3 +
2. Respirations of 10 breaths/minute
3. Presence of deep tendon reflexes
4. Serum magnesium level of 6 mEq/L

Answer 24

2. Respiration of 10 bpm

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.
Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L. Proteinuria of 3 + is an expected finding in a client with
preeclampsia.

Question 25

``` 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 ```

Answer 25

, 4, 5 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. Therapeutic serum levels of magnesium are 4 to 7.5 mEq/L. Proteinuria of 3 + is an expected finding in a client withpreeclampsia.

Question 26

The nursing instructor 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? 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.”

Answer 26

1. 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.

Question 27

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 (Nubain) 2. Betamethasone (Celestone) 3. Rho (D) immune globulin (RhoGAM) 4. Dinoprostone (Cervidil vaginal insert)

Answer 27

2. Bethamathasone (Celestone) 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 (Nubain) is an opioid analgesic. Rho(D) immune globulin (RhoGAM) is given to Rhnegative clients to prevent sensitization. Dinoprostone (Cervidil vaginal insert) is a prostaglandin given to ripen and soften the cervix and to stimulate uterine contractions.

Question 28

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

Answer 28

2. Blood Pressure 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 should be notified if hypertension is present. Although options 1, 3, and 4 may be components of the postpartum assessment, the correct option, blood pressure, is related specifically to the administration of this medication. Test-Taking Strategy: Note the strategic word priority. Eliminate options 1 and 3 first because they are comparable or alike and related to one another. To choose from the remaining options, use the ABCs—airway, breathing, and circulation. Blood pressure is a method of assessing circulation.

Question 29

The nurse is preparing to administer beractant (Survanta) to a premature infant who has respiratory distress syndrome. The nurse plans to administer the medication by which route? 1. Intradermal 2. Intratracheal 3. Subcutaneous 4. Intramuscular

Answer 29

2. Intratracheal 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.

Question 30

An opioid analgesic is administered to a client in labor. The nurse assigned to care for the client ensures that which medication is readily available if respiratory depression occurs? 1. Naloxone 2. Morphine sulfate 3. Betamethasone (Celestone) 4. Meperidine hydrochloride (Demerol

Answer 30

1. Naloxone 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 meperidine hydrochloride are opioid analgesics. Betamethasone is a corticosteroid administered to enhance fetal lung maturity.

Question 31

Rho (D) immune globulin (RhoGAM) 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

Answer 31

4. Being affected by Rh incompability 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 (RhoGAM) prevents the mother from developing antibodies against Rh-positive blood by providing passive antibody protection against the Rh antigen.

Question 32

Methylergonovine (Methergine) is prescribed for a client with postpartum hemorrhage. Before administering the medication, the nurse contacts 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

Answer 32

4. Peripheral vascular disease 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