Chapter 44: Uterine Drugs Introductory Clinical Pharmacology 12th Edition by Susan M Ford

Introductory Clinical Pharmacology 12th Edition by Susan M Ford 1. A client is prescribed oxytocin for intranasal use. The nurse will explain to the client this will achieve which result? a. Antistimulating properties on the uterus b. Diuretic effect c. Stimulation of the milk ejection reflex d. Control of antepartum bleeding Answer: C Rationale: Oxytocin, when administered intranasally, stimulates the milk ejection (milk letdown) reflex. Oxytocin has uterine-stimulating properties, not antistimulating properties, on the uterus. Tocolytics have an antistimulating effect on the uterus. Oxytocin has an antidiuretic effect, which might lead to a danger of excessive fluid volume (water intoxication), and not a diuretic effect. Oxytocin is given IM during the third stage of labor to produce uterine contractions and control postpartum, and not antepartum, bleeding and hemorrhage. Question Format: Multiple Choice Chapter: 44 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 593, Other Uterine Stimulants 2. A pregnant woman at 40 weeks gestation has been prescribed oxytocin IV. Which interventions would the nurse prioritize before administering the oxytocin? a. Ask the client to drink plenty of water. b. Obtain an obstetric and general health history. c. Examine for signs of water intoxication. d. Place the client in an upright position. Answer: B Rationale: Before starting an IV infusion of oxytocin to induce labor, the nurse should obtain a complete obstetric history (e.g., parity, gravidity, previous obstetric problems, type of labor, stillbirths, abortions, live-birth infant abnormalities) and a general health history. Clients should not have water before labor, as the oxytocin may lead to water intoxication. The nurse should examine for any signs of water intoxication or fluid overload as a sign of an adverse reaction to the drug and need not assess this before administration of the medication. Placing the client in an upright position is advised when oxytocin is administered intranasally to facilitate the letdown of milk for breastfeeding. Question Format: Multiple Choice Chapter: 44 Learning Objective: 2 Cognitive Level: Apply Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 594, Client Receiving an Oxytocic Drug 3. A client receiving magnesium sulfate shows signs of dyspnea, tachycardia, increased respiratory rate and rales, and a frothy sputum on the ongoing assessment. Which condition should the nurse suspect the client is developing? a. Pulmonary edema b. Water intoxication c. Renal failure d. Cardiac arrest Answer: A Rationale: The client is most likely experiencing pulmonary edema. If there is an increase in respiratory rate of more than 20 respirations/min with the administration of magnesium sulfate, the nurse should assess the respiratory status for symptoms of pulmonary edema such as dyspnea, tachycardia, rales, and frothy sputum. In such cases, the primary health care provider is notified immediately because use of the drug may be discontinued or the dosage may be decreased. The danger of water intoxication is associated with oxytocin as it has an antidiuretic effect, and not with magnesium sulfate. Renal failure and cardiac arrest are not associated with magnesium sulfate. Question Format: Multiple Choice Chapter: 44 Learning Objective: 3 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 598, Impaired Gas Exchange 4. A 30-year-old pregnant woman has been prescribed oxytocin. After assessing the client's drug regimen and noting the client is also prescribed vasopressors, the nurse will carefully monitor the client for which potential adverse reaction? a. Anaphylactic shock b. Hypertension c. Respiratory failure d. Heart attack Answer: B Rationale: Combining oxytocin with vasopressor drugs increases the risk of severe hypertension. Combining oxytocin and vasopressors does not increase the risk of heart attack or respiratory failure. Anaphylactic shock is associated with a hypersensitivity reaction and does not occur with the interaction of vasopressors and oxytocin. Question Format: Multiple Choice Chapter: 44 Learning Objective: 1 Cognitive Level: Apply Client Needs: Physiological Integrity: Reduction of Risk Potential Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 593, Other Uterine Stimulants 5. A 31-year-old pregnant woman has been prescribed a tocolytic drug. The nurse will explain to the client that this drug class is used primarily for which reason? a. Antepartum hypertension b. Preterm labor c. Postpartum hemorrhage d. Protracted labor Answer: B Rationale: Drugs used to prevent uterine contractions are called tocolytics. They are useful in the management of preterm labor. These drugs will decrease uterine activity and prolong the pregnancy to allow the fetus to develop more fully, thereby increasing the chance of neonatal survival. Oxytocic drugs are used antepartum (before birth of the neonate) to induce uterine contractions and initiate or augment labor. They can also be used to help control postpartum bleeding and lessen hemorrhage potential. Tocolytics are not used for postpartum hemorrhage or protracted labor. Question Format: Multiple Choice Chapter: 44 Learning Objective: 1 Cognitive Level: Understand Client Needs: Physiological Integrity: Pharmacological Therapies Integrated Process: Clinical Problem-solving Process (Nursing Process) Reference: p. 596, Tocolytics 6. A nurse is caring for a pregnant client in the third stage of labor. The nurse would prepare to administer oxytocin by which route to this client?