Maternity and Newborn Medication (Chap 35) Flashcards Preview

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1
Q

Tocolytics

A

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

2
Q

Tocolytic medication Indomethacin

A

Indomethacin (Indocin)

relaxes uterine smooth muscle

3
Q

Tocolytic medication: Magnesium sulfate

A

central nervous system depressant

  • relaxes smooth muscle, including the uterus
  • used to halt preterm labour contraction
  • also used for preeclamptic clients to prevent seizures
4
Q

Tocolytic medication: Nifedipine

A

Nifedipine (procardia, adalat, nifedical)

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

5
Q

Tocolytic medication: Terbutaline

A

adrenergic agonist

- relaxes smooth muscle, inhibiting uterine activity and causes brocholilation

6
Q

What is the antidote to magnesium sulfate?

A

Calcium Gluconate

7
Q

True or False

Magnesium Sulfate is contraindicated for clients that have kidney disease?

A

TRUE

8
Q

What is the target range for Magnesium Sulfate?

A

4-7.5 mEq/L

9
Q

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

A

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

10
Q

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

A

Opioid Analgesic

11
Q

What are some symptoms of newborn withdrawn?

A

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

12
Q

What is the antidote for opioids?

A

Naloxone (Narcan)

13
Q

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

A
Meperidine Hydrochloride (Demerol)
Hydromorphone Hydrochloride (Dilaudid)
14
Q

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

A

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

15
Q

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

A

Prostaglandins

- they stimulate uterine contractions and are administered vaginally

16
Q

Name 2 prostaglandin medications:

A

Misoprostol (Cytotec)

Dinoprostone (Cervidil)

17
Q

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

A

6-12 after the discontinuation of prostaglandin therapy

18
Q

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

A

Oxytocin (Pitocin)

19
Q

Oxytocin also promotes __________.

A

milk letdown

20
Q

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
A

Oxytocin (Pitocin)

21
Q

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

A

28 weeks

72 hours after delivery

22
Q

What is Phytonadione?

A

Vitamine K

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

23
Q

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

A
  1. 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.

24
Q

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

A
  1. 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.

25
Q
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
A

, 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.

26
Q

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.”

A

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.

27
Q

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)

A
  1. 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.

28
Q

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

A
  1. 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.

29
Q

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

A
  1. 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.

30
Q

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

A
  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.

31
Q

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

A
  1. 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.

32
Q

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

A
  1. 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