Chapter 53: Female Reproductive Cycle I: Pregnancy and Preterm Labor Drugs Nursing School Test Banks

Chapter 53: Female Reproductive Cycle I: Pregnancy and Preterm Labor Drugs
Test Bank

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.
b. has reduced renal elimination resulting in toxicity.
c. is more sensitive to metabolism by circulating maternal hormones.
d. will be more likely to cross the placenta and affect the fetus.
ANS: D
Low-molecular weight drugs are more likely to cross the placental barrier. 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) REF: Page 778
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) REF: Page 778
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Health Promotion and Maintenance: Antepartal Care

3. Which statement by the nurse is accurate regarding iron supplementation during pregnancy?
a. All women should take iron supplements throughout their pregnancy.
b. Iron supplements are given to supply the fetus.
c. Iron supplements usually are not necessary until the second trimester.
d. The greatest iron demand is in the first trimester of pregnancy.
ANS: C
Iron supplements generally are not necessary until the second trimester when the fetus begins to store iron. 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) REF: Page 780
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
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.
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) REF: Page 780
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is teaching a woman who is pregnant about iron supplementation. Which statement by the woman indicates understanding of the teaching?
a. I may take the iron with an antacid to reduce gastrointestinal upset.
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 and tarry.
ANS: C
Orange juice helps to improve absorption. Antacids and milk interfere with absorption. Black, tarry stools are an expected side effect and do not warrant stopping the supplement.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 787
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
a. 60 mg of elemental iron per day
b. 400 mg of folic acid per day
c. 400 IU of vitamin D per day
d. 1200 mg of calcium per day
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) REF: Page 781
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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 action?
a. Avoid fatty foods.
b. Drink fluids with meals.
c. Eat a large lunch and dinner.
d. Take an iron supplement in the morning.
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) REF: Page 781
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Health Promotion and Maintenance: Antepartal Care

8. A pregnant woman asks the nurse if she must give up caffeinated coffee while pregnant. How will the nurse advise the patient?
a. Two cups of coffee can increase your risk of spontaneous abortion.
b. Drinking fewer than 6 cups of coffee per day is not harmful.
c. You may consume coffee freely during your third trimester.
d. There is evidence that caffeine is teratogenic.
ANS: A
Two cups of coffee per day increase epinephrine and decrease intervillous blood flow with a potential for spontaneous abortion. Although an amount greater than 6 to 8 cups per day is likely to be toxic to the embryo, there is no evidence that caffeine is teratogenic. The risk is consistent throughout the pregnancy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 779
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 to 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 not be given to 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 not be given to 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) REF: Page 783
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
a. Alka-Seltzer
b. Magaldrate
c. Pepcid
d. TUMS
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 such as hydroxymagnesium aluminate (Magaldrate). Alka-Seltzer contains baking soda and can be harmful during pregnancy. A histamine2 receptor antagonist, such as Pepcid, may be used, but only if recommended by the provider. TUMS contain calcium, which can be constipating during pregnancy.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 786
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. A pregnant woman reports having constipation and has tried dietary changes without success. What will the nurse recommend?
a. Bisacodyl (Dulcolax)
b. Mineral oil
c. Psyllium (Metamucil)
d. Senna (Senokot)
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) REF: Page 785
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 NSAIDs
a. will affect her fetus.
b. have renal toxicity.
c. induce premature labor.
d. 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) REF: Page 786
TOP: NURSING PROCESS: Nursing Intervention: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
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.
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) REF: Page 792
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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?
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.
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) REF: Page 792
TOP: NURSING PROCESS: Implementation
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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 hours. 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?
a. Abruptio placenta
b. Hypertensive crisis
c. Impending eclampsia
d. Magnesium toxicity
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. Patients with severe eclampsia will have marked elevation of blood pressure and seizures.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 794
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. Circulating steroid hormones
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
Steroid hormones, 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) REF: Page 778
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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