PHARMACOLOGICAL AND PARENTERAL THERAPIES DURING CHILDBEARING QUESTIONS/ANSWERS (NEW EDITION) Download to Score

PHARMACOLOGICAL AND PARENTERAL THERAPIES DURING CHILDBEARING QUESTIONS/ANSWERS 1. The nurse is assessing the female client who is taking clomiphene. Which finding should indicate to the nurse that the client is experiencing an adverse effect of the medication? A. Pelvic pain B. Nipple discharge C. Weight gain D. Watery diarrhea ANSWER: A A. Pelvic pain may indicate ovarian enlargement from overstimulation of the ovary. B. Breast tenderness rather than nipple discharge may occur as an adverse effect of clorniphene. C. Weight gain is not associated with the use of clomiphene. D. Watery diarrhea is not associated with the use of clomiphene. 2. The client who is 5 weeks pregnant asks the nurse for information about mifepristone use for medical abortion- Which statements, if made by the nurse, are accurate? Select all that apply. A. “It must be taken immediately after your last menstrual cycle to be effective.” B. “It will block the action of progesterone on the uterus so that the fetus is aborted.” C. “Mifepristone must be followed up with a vaginal douche of vinegar and water.” D. “The success rate is very high, especially if taken within 42 days of conception.” E. “Mifepristone is given intravenously (IV) in the health care provider’s office.” F. “Many develop a transient temperature elevation after taking mifepristone.” ANSWER: B, D A. Mifepristone does not need to be taken immediately after the last menstrual cycle; however, to achieve a success rate at or above 91%, it should be taken within 49 days of conception. B. Mifepristone (Mifeprex) blocks the uterine progesterone receptors in the uterus, thereby altering the endometrium and causing the detachment of the conceptus. C. Douching is not required for abortion to occur with mifepristone. D. The abortion success rate for mifepristone is 96% to 98% when taken within 42 days of conception. E. Mifepristone is given orally, not intravenously. F. Temperature elevation is a sign of infection and should be reported immediately to the HCP. 3. Prior to administering platelets to a postpartum client with worsening HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count), the nurse reviews the client’s laboratory results. Place an X in the blank column next to each laboratory value that suggests I-IELLP syndrome. Hemolysis (low RBCs), elevated liver enzymes (albumin, AST, ALT, ALP, and total bilirubin), and a low platelet count are hallmarks of HELLP syndrome. The cause of HELLP syndrome is a genetic disorder of fatty acid oxidation in the fetus of the pregnant woman. Some women may experience worsening HELLP syndrome over the first 48-hour postpartum period. Although the WBCs are elevated and the serum potassium low, these are not associated with HELLP syndrome. 4. The client, preparing to receive vaccinations at a walk-in clinic, tells the nurse she thinks she may be pregnant. Which vaccine, if needed, should the nurse prepare to administer to this client? A. Rubella B. Varicella C. Hepatitis B D. Mumps ANSWER: C A. Rubella should not be administered to pregnant women because it contains live virus, which is contraindicated during pregnancy. B. Varicella should not be administered to pregnant women because it contains live virus, which is contraindicated during pregnancy. C. Hepatitis B vaccination can be safely administered during pregnancy because it is a synthetically prepared or DNA-recombinant vaccine. The vaccine is made of noninfectious material and cannot cause hepatitis B infection. Hepatitis B may spread to the fetus if the mother is infected in the third trimester. D. Mumps should not be administered to pregnant women because it contains live virus, which is contraindicated during pregnancy. 5. The pregnant client who is prescribed supplemental vitamin D during pregnancy asks the nurse why vitamin D is so important. Which responses by the nurse are correct? Select all that apply. A. “Almost 50% of pregnant women lack sufficient vitamin D levels during late pregnancy.” B. “A low level of vitamin D is associated with reduced bone-mineral accumulation during your child’s growing years.” C. “A low level of vitamin D may predispose you to premature rupture of your membranes.” D. “A low level of vitamin D causes a breakdown of cervical collagen, prompting early cervical dilation.” E. “Vitamin D supplements taken during pregnancy may reduce the risk for osteoporosis- related fractures in your child.” ANSWER: A, B, E A. This re5ponse is correct. Research has shown that vitamin D levels during late pregnancy were insufficient in 31% and deficient in 18% of pregnant women. B. This response is correct. A low level of vitamin D is associated with a child’s reduced bone-mineral accumulation at age 9 years. C. A low level of vitamin C (not D) predisposes the client to premature rupture of the membranes. D. The lack of vitamin C (not D) increases the rate of cervical collagen degradation. With decreased collagen, the cervix ripens more easily, prompting efiacement and dilation. E. This response is correct. Supplements taken during pregnancy may reduce the child’s risk for osteoporosis-related fractures. 6 . The nurse is assessing a newly pregnant Client. Which finding indicates that the client may need iron supplementation? A. Gave birth a year ago B. Over 35 years of age C. First pregnancy D. Primary infertility ANSWER: A A. Pregnancy depletes iron stores, which are generally replaced with a well-balanced diet between gestation periods. When the second pregnancy is closely spaced, the iron stores have not been adequately replaced. B. Advanced maternal age is not associated with nutritional disorders. C. A first pregnancy is not a nutritional risk factor, although pregnant adolescents are considered to be at nutritional risk. D. Infertility is not usually associated with nutritional risk factors. 7. The nurse is caring for the client with hyperemesis gravidarum- Which agents, if prescribed by the HCP, should the nurse question? Select all that apply. A. Pyridoxine (vitamin B6) 50 mg oral daily B. Promethazine 12.5 mg IV q4h C. Dimenhydrinate 50 mg oral q4-6 h pm D. Metoclopramide 100 mg IM q8h E. Ginger capsule l g oral daily F. Prochlorperazine 30 mg oral daily ANSWER: D, F A. Pyridoxine has antiemetic effects and is used for treating nausea and vomiting of pregnancy. Its dose, route, and frequency are within the recommended range. B. Promethazine (Phenergan) has antiemetic effects and is used for treating nausea and vomiting of pregnancy. Its dose, route, and frequency are within the recommended range. C. Dimenhydrinate (Dramamine) has antiemetic effects and is used for treating nausea and vomiting of pregnancy. Its dose, route, and frequency are within the recommended range. D. The dose of metoclopramide (Reglan) is 10 times the usual dose; it should be 10 mg and not 100 mg. E. Ginger has antiemetic effects and is used for treating nausea and vomiting of pregnancy. Its dose, route, and frequency are within the recommended range. F. Prochlorperazine (Compazine) is also a pregnancy Category C drug, indicating that its safety has not been established for use during pregnancy. 8. The pregnant client presents to a clinic with a white, cottage cheese—like vaginal discharge, itching, and vulvar redness. The nurse should pre- pare to teach the client about which appropriately prescribed medication? A. Metronidazole 250 mg orally bid for 1 week B. Butoconazole vaginal cream once at bedtime C. Imidazole vaginal cream daily for 1 week D. Fluconazole 150 mg by mouth once ANSWER: C A. Metronidazole (Flagyl) is used for the treatment of bacterial vaginosis, not Candida albicans, as the symptoms suggest. B. Butoconazole (Gynazole) should not be used in pregnancy. C. The nurse should prepare to teach the client about the use of imidazole vaginal cream. It is indicated for the treatment of Candida albicans, and it is safe in pregnancy. D. One-time treatment with fluconazole (Ditlucan) has not been well studied during pregnancy and therefore should not be used. 9. Benazepril is added to the antihypertensive medication regimen of an African American client who is 30 weeks pregnant. Which nursing intervention is most important? A. Withhold the benazepril and contact the HCP. B. Monitor for a diminished effect in lowering her BP. C. Notify the HCP if the serum bilirubin level increases. D. Notify the HCP if the serum potassium level increases. ANSWER: A A. Benazepril (Lotensin) may cause fetal injury and death. Is it most important for the nurse to withhold the benazepril and contact the HCP. B. Although African American clients have a diminished therapeutic response to ACE inhibitors, benazepril should not be administered due to its teratogenic effects. C. Although benazepril will increase serum bilirubin levels, withholding the benazepril is nrore important. D. Although benazepril will increase serum potassium levels by inhibiting aldosterone secretion, with- holding the benazepril is nrore important. 10. The client, who is 8 weeks pregnant, tells the nurse that she wants to try an herbal or natural remedy for treating her nausea. Which herb should the nurse suggest? A. Ginger B. Milk thistle C. Black cohosh D. Echinacea ANSWER: A A. Ginger capsules of 250 mg taken four times a day have been demonstrated to be effective against nausea and vomiting associated with pregnancy, as well as hyperemesis. There is no evidence of significant side effects or adverse effects on pregnancy outcomes. B. Milk thistle does not have an effect on nausea. The seeds of the milk thistle plant exert hepatoprotective and antihepatotoxic action over liver toxins. Milk thistle also activates the liver‘s regenerative capacity, making this herb beneficial in the treatment of hepatitis. C. Black cohosh is an herbal remedy used to treat menopausal and premenstrual syndrome symptoms but has no effect on nausea. D. Echinacea is used to stimulate the immune system but has no effect on nausea. 11. The client who is 28 weeks pregnant and experiencing heartburn is prescribed to take omeprazole. The nurse educating the client about omeprazole should explain that it reduces heartburn by which action? A. Blocks the action of the enzyme that generates gastric acid B. Blocks the H2 receptor located on the parietal cells of the stomach C. Neutralizes the gastric acid in the stomach D. Coats the upper stomach and esophagus to decrease irritation from stomach acid ANSWER: A A. Omeprazole (Prilosec), a PPl, produces irreversible inhibition of H”, K+-ATPase, which is the enzyme that induces gastric acid production. B. Option 2 describes histamine blockers such as ranitidine (Zantac). C. Option 3 describes the action of antacids. D. Option 4 describes sucralfate (Carafate). 12. The nurse receives medication orders for the client who is 28 weeks pregnant and experiencing CHF. Which medication should be clarified with the HCP before administration? A. Furosemide 40 mg IV bid B. Captopril 25 mg PO daily C. Digoxin 0.125 mg IV daily D. Metoprolol SR 50 mg PO daily ANSWER: B A. Furosenride (Lasix), a diuretic, is a Category C medication. It has not been shown to cause fetal harm and may be administered in pregnancy. B. The nurse should clarify captopril (Capoten), an ACE inhibitor. ACE inhibitors are contraindicated in the second and third trimesters of pregnancy. They can cause oligohydramnios, intrauterine growth retardation (IUGR), congenital structural defects, and renal failure. C. Digoxin (Lanoxin) is a Category C medication but has not been shown to cause fetal harm. Digoxin exerts a positive inotropic action on the heart. D. Metoprolol (Toprol XL) is a Category C medication but has not been shown to cause fetal harm. Metoprolol, which is a beta blocker, can improve left ventricular ejection fraction and slow the progression of heart failure. 13. The pregnant client with HIV is receiving highly active antiretroviral therapy (HAART) at an outpatient HIV Center. The nurse should monitor the client for which potential pregnancy-related problems associated with HAART therapy? Select all that apply. A. Preterm labor B. Preeclampsia C. Low birth weight D. Gestational diabetes E. Birth defects ANSWER: A, C, D A. Women receiving HAART during pregnancy are at higher risk for preterm labor. B. There is no known association between HAART and preeclampsia. C. Women receiving HAART during pregnancy are at higher risk for low-birth-weight babies. D. Women receiving HAART during pregnancy are at higher risk for gestational diabetes. E. There is no known association between HAART and birth defects. 14. The nurse is checking the medical records of second-trimester clients for newly prescribed medications. The nurse should contact the HCP regarding incomplete information for which prescription? A. Methyldopa 250 mg bid by mouth for elevated BP B. MgSO4 5 g IM for BP 160/90 mm Hg X 2 readings C. Terbutaline 5 mg q6h by mouth for preterm labor D. Prenatal vitamins one tablet daily by mouth ANSWER: B A. Methyldopa (Aldomet) 250 mg bid by mouth for elevated BP is correctly written. B. According to the Joint Commission, certain abbreviations should not be used because of different meanings. MgSO4 (magnesium sulfate) can be confused with MSO4 (morphine sulfate) and should be written out as magnesium sulfate. The and symbols may be added to the list in the near future and should also be avoided when writing orders or other medical documentation. C. Terbutaline (Brethine) is a bronchodilator that is used off-label to treat preterm labor, and is correctly written. D. Prenatal vitamins one tablet daily by mouth is correctly written. 15. The client, at 25.2 weeks’ gestation in preterm labor, is given nifedipine and then magnesium sulfate to stop her contractions. When assessing the client, which findings by the nurse indicate that the client is experiencing an adverse effect from the magnesium sulfate? Select all that apply. A. Shortness of breath B. Flushing C. Hypertension D. Hyporeflexia E. Insomnia ANSWER: A, B, D A. Shortness of breath is an adverse effect of magnesium sulfate (Citro Mag). B. Flushing is an adverse effect of magnesium sulfate due to its direct dilating effects. C. Hypotension (not hypertension) is an adverse effect of magnesium sulfate due to its direct dilating effects. D. Hyporeflexia (flaccidity) is an adverse effect of magnesium sulfate due to its toxic effect on the CNS. The magnesium dose should be reduced or eliminated. E. Insomnia is not an adverse effect of magnesium sulfate.