Chapter 49: Pregnancy and Preterm Labor McCuistion: Pharmacology: A Patient-Centered Nursing Process Approach, 10th Edition

Multiple Choice

1. A pregnant woman asks the nurse about whether a medication is safe to take during pregnancy. The nurse notes that the drug has a low-molecular weight. Based on this drug characteristic, the nurse understands that this drug: a. can cause greater gastrointestinal distress and hyperemesis when compared to high-molecular weight drugs. b. has reduced renal elimination resulting in toxicity when compared to high-molecular weight drugs. c. is more sensitive to metabolism by circulating maternal hormones when compared to high-molecular weight drugs. d. will be more likely to cross the placenta and affect the fetus when compared to high-molecular weight drugs.

ANS: D

Low–molecular-weight drugs are more likely to cross the placental barrier when compared to high-molecular weight drugs. This characteristic does not contribute to increased GI distress or toxicity because of reduced renal elimination. Drugs with low-molecular weight are not more sensitive to metabolism by maternal hormones.

DIF: Cognitive Level: Understanding (Comprehension) TOP: Nursing Process: Analysis

MSC: NCLEX: Health Promotion and Maintenance: Antepartal Care

2. A woman who is 4 weeks pregnant is worried that a medication she took until 3 weeks ago may cause birth defects. The nurse will tell her that: a. drugs taken in the first week of pregnancy can cause CNS defects. b. medications have increased teratogenicity during the first week of pregnancy. c. she should have an ultrasound immediately. d. teratogenic effects are rare in the first 2 weeks of pregnancy.

ANS: D

During the first 2 weeks, the embryo is not susceptible to teratogenesis. There is no need for an ultrasound.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Health Promotion and Maintenance: Antepartal Care a. “Women should only take an iron supplement if they have a documented serum iron deficiency.” b. “Iron supplements are given to supply the fetus.” c. “Low-dose iron supplementation is recommended starting at the first prenatal appointment.” d. “The greatest iron demand is in the first trimester of pregnancy.”

3. Which statement by the nurse is accurate regarding iron supplementation during pregnancy?

ANS: C

Low-dose iron supplementation is recommended by the CDC starting at the first prenatal appointment. Iron supplements are given to prevent maternal iron deficiency, not to supply the fetus. The greatest demand occurs in the third trimester.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “Continue taking iron for 6 more weeks.” b. “Stop taking the iron supplement now.” c. “Take the iron supplement while nursing.” d. “Take the iron only if your hemoglobin is low.”

4. A patient who has just delivered her baby asks the nurse if she needs to continue taking her iron supplement. What instruction will the nurse provide to the patient?

ANS: A

Women should continue taking an iron supplement for 6 weeks after delivery. It is not necessary to take iron for the duration of nursing.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. “I may take the iron with an antacid to reduce gastrointestinal upset.”

5. The nurse is teaching a woman who is pregnant about iron supplementation. Which statement by the woman indicates understanding of the teaching?

N b. “I should drink a glass of milk with iron to increase absorption.” c. “I should take the iron supplement with a glass of orange juice.” d. “I will stop taking the iron if my stools turn black.”

ANS: C

Orange juice helps to improve absorption. Antacids and milk interfere with absorption. Darkened stools are an expected side effect and do not warrant stopping the supplement.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. 60 mg of elemental iron per day b. 400 mcg of folic acid per day c. 400 IU of vitamin D per day d. 1200 mg of calcium per day

6. A young woman who is contemplating pregnancy asks the nurse what she can do to get healthy in preparation for pregnancy. The nurse will recommend which dietary supplement?

ANS: B

Folic acid can help prevent neural tube defects. All women of childbearing age should take folic acid supplements. The other supplements may be given during pregnancy but are not recommended prior to getting pregnant.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Avoid fatty foods. b. Drink fluids with meals. c. Eat a large lunch and dinner. d. Take an iron supplement in the morning.

7. A pregnant woman who has morning sickness asks the nurse what she can do to decrease her symptoms. The nurse will counsel her to take which of the following initial actions?

ANS: A

Avoiding fatty foods is a nonpharmacologic measure to reduce nausea and vomiting. Patients should drink fluids between and not with meals. Taking iron in the morning is not recommended. The pregnant woman should eat small, frequent meals.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Health Promotion and Maintenance: Antepartal Care a. “Limit your coffee consumption to 1 cup per day and avoid other sources of caffeine, such as tea and soda.” b. “Drinking fewer than 6 cups of coffee per day is not harmful.” c. “You may consume coffee freely during your third trimester.” d. “Caffeine does not appear in breast milk.”

8. A pregnant woman asks the nurse if she must give up caffeinated coffee while pregnant and breast feeding. How will the nurse advise the patient?

ANS: A

Caffeine consumption should be limited, and patients should be advised to limit coffee ingestion to 1 cup per day and to limit consumption of other sources of caffeine (tea, soda, chocolate and certain drugs). One percent of caffeine consumed will appear in breast milk, so it is wise to not drink several cups of coffee in succession.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

9. The nurse is caring for a patient who is 6–7 weeks pregnant and has moderate to severe vomiting. The provider has ordered doxylamine (Unisom) and intravenous fluids. The patient reports a history of asthma and type 2 diabetes mellitus. The nurse will hold the drug and contact the provider because doxylamine should be used with caution in patients who: a. are pregnant. b. are in their first trimester. c. have asthma. d. have diabetes.

ANS: C

Doxylamine is used for nausea and vomiting during pregnancy. It should be used cautiously in patients who have asthma. It may be given to pregnant women in their first trimester. Diabetes is not a contraindication.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Sodium bicarbonate b. Magnesium and aluminum containing antacids c. H-2 receptor antagonist d. Calcium carbonate

10. A woman who is pregnant tells the nurse she has frequent heartburn in spite of eating small meals slowly; avoiding greasy, gas-forming foods; and remaining upright for 30 minutes after eating. The nurse will recommend which over-the-counter product?

ANS: B

If a pregnant patient does not respond to nonpharmacologic therapy, antacids are first-line therapy, and patients should choose a nonsystemic low-sodium product that contains aluminum and magnesium in combination. Products that contain sodium bicarbonatecan be harmful during pregnancy. A histamine2 receptor antagonist, such as Pepcid, may be used, but only if recommended by the provider. Calcium-containing antacids can be constipating during pregnancy.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. A stimulant laxative like bisacodyl (Dulcolax) b. Mineral oil c. A bulk-forming laxative like psyllium (Metamucil) d. A stimulant laxative like senna (Senokot)

11. A pregnant woman reports having constipation and has tried dietary changes without success. What will the nurse recommend?

ANS: C

Bulk-forming laxatives, like psyllium, should be tried first because they are not systemically absorbed. Bisacodyl and senna have systemic effects. Mineral oil can reduce the absorption of fat-soluble vitamins.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

12. A woman who is in her third trimester of pregnancy asks the nurse why she cannot take ibuprofen instead of acetaminophen for headaches. The nurse will explain that ibuprofen: a. will affect her fetus. b. use will result in renal toxicity. c. will induce premature labor. d. will prolong labor.

ANS: A

Ibuprofen can cause premature closure of the ductus arteriosus in the fetus if taken late in the pregnancy. Aspirin can induce premature labor and prolong labor.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention: Patient Teaching

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. It lowers her blood pressure and prevents seizures. b. It prevents closure of the ductus arteriosus. c. It prevents respiratory distress in her infant. d. It stops her contractions.

13. A woman who is experiencing premature labor is being given betamethasone (Celestone). She asks the nurse why this drug is being given. The nurse will explain that betamethasone is given for which reason?

ANS: C

The medication is given to accelerate lung maturation and lung surfactant development in the fetus in utero. It does not lower maternal blood pressure, stop maternal contractions, or prevent closure of the fetal ductus arteriosus.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Nursing Intervention

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. It will decrease uterine contractions. b. It will enhance fetal lung development. c. It will increase fetal blood supply. d. It will lower her blood pressure.

14. The nurse is caring for a woman who is experiencing premature labor. The provider has ordered intravenous terbutaline (Brethine) to be given. The nurse will explain that this medication will have which action?

ANS: A

Terbutaline is given to relax the smooth muscle of the uterus and decrease contractions in order to stop premature labor. It does not affect fetal lung development or fetal blood supply and does not lower maternal blood pressure.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Implementation

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies a. Abruptio placenta b. Hypertensive crisis c. Impending eclampsia d. Magnesium toxicity

15. The nurse is caring for a woman who is in labor and has a blood pressure of 180/98 mm Hg with proteinuria of 400 mg/24 h. The woman is receiving magnesium sulfate. The woman becomes lethargic with slurring of her speech and decreased muscle tone. Her serum magnesium sulfate level is 11 mEq/L. The nurse recognizes which condition in this patient?

ANS: D

Patients receiving magnesium sulfate can develop toxicity, evidenced by lethargy, slurred speech, and decreased muscle tone. A level greater than 10 mEq/L indicates toxicity. An elevated blood pressure and proteinuria are expected findings in a patient with pre-eclampsia. Patients with eclampsia will have marked elevation of blood pressure and seizures.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

16. A woman who is experiencing preeclampsia asks what changes she has to make to her routine to minimize the risk of worsening her condition. The nurse will explain that she should: a. lie on her right side when sleeping. b. be hospitalized for the remainder of the pregnancy. c. restrict her fluids to 1000 mL/day. d. reduce her level of activity.

ANS: D

Nonpharmacologic treatments for preeclampsia include activity reduction, lying on left side, drinking six to eight 8-ounce glasses of water a day. There is no need for hospitalization if the condition can be controlled.

DIF: Cognitive Level: Applying (Application)

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

Multiple Response

1. Which are physiologic changes during pregnancy that affect drug absorption, metabolism, distribution, and excretion? (Select all that apply.)

a. Changes in hormone levels b. Decreased gastrointestinal motility c. Decreased renal perfusion d. Increased maternal circulatory blood volume e. Poor sleep and fatigue f. Rapid respiratory rate

ANS: A, B, D

Changes in hormone levels, decreased GI motility, and increased blood volume all affect maternal drug effectiveness. Renal perfusion is increased during pregnancy. Poor sleep does not alter drug effectiveness. Rapid respiratory rate does not necessarily occur.

DIF: Cognitive Level: Understanding (Comprehension)

TOP: Nursing Process: Assessment

MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies