Chapter 54: Female Reproductive Cycle II: Labor, Delivery, and Preterm Neonatal Drugs Nursing School Test Banks

Chapter 54: Female Reproductive Cycle II: Labor, Delivery, and Preterm Neonatal Drugs
Test Bank

MULTIPLE CHOICE

1. The nurse is caring for a woman who is in early labor. The woman wants to avoid pain medications as long as possible. What will the nurse tell her?
a. I can give you a sedative-hypnotic now to help you relax.
b. I can teach you some simple breathing exercises to help lessen discomfort.
c. If you take fentanyl (Sublimaze) now, it will be more effective than if you wait.
d. You may take ibuprofen, which wont cause drowsiness.
ANS: B
Breathing and relaxation techniques are often used as nonpharmacologic measures to control pain during labor. Sedatives are often used to decrease maternal anxiety during false labor, latent labor, or with ruptured membranes without true labor. Fentanyl is generally not given until active labor. Ibuprofen can cause premature closure of the ductus arteriosis.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 801
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

2. The nurse administers meperidine (Demerol) to a woman who is in early labor. Immediately after the drug is given, the womans labor progresses quickly, and she delivers her infant. The nurse will monitor the infant closely for which condition?
a. Opioid withdrawal syndrome
b. Orthostatic hypotension
c. Respiratory depression
d. Tachycardia and poor perfusion
ANS: C
Narcotic analgesics cause respiratory depression in the infant if given shortly before delivery. The nurse should monitor the infant closely and prepare to give naloxone (Narcan) if this occurs. Opioid withdrawal occurs with prolonged exposure to opioids. Orthostatic hypotension and tachycardia are not common effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 802
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

3. The nurse is caring for an infant who is 2 days postpartum and notes that the infant has a poor sucking response. The nurse reviews the delivery record and will likely note that which drug was given to the mother during labor?
a. Butorphanol tartrate (Stadol)
b. Fentanyl (Sublimaze)
c. Nalbuphine (Nubain)
d. Secobarbital (Seconal)
ANS: D
Sedative-hypnotic drugs, such as secobarbital, can cause neonatal respiratory depression, hypotonia, and a poor sucking response up to 4 days. Butorphanol tartrate, fentanyl, and nalbuphine do not have prolonged effects.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 802
TOP: NURSING PROCESS: Assessment
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

4. The nurse is caring for a woman who is in active labor and wants to receive a drug for severe pain immediately. Her intravenous line has just infiltrated. The nurse will perform which action?
a. Administer fentanyl intramuscularly.
b. Contact the provider for an order for IM meperidine (Demerol).
c. Give the woman promethazine (Phenergan)
d. Request an order for hydroxyzine (Vistaril).
ANS: B
Meperidine may be given IM and is the most commonly used opioid during labor. Fentanyl is best given intravenously. Promethazine is given in combination with opioids during active labor to potentiate the analgesic action of the opioids and minimize emesis. Hydroxyzine is given for nausea.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 802
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

5. The nurse is caring for a woman who is in labor. The woman is anxious and reports increasing nausea after receiving an opioid analgesic medication. The nurse will contact the provider and request an order for which intravenous medication?
a. Hydroxyzine HCl (Vistaril)
b. Pentobarbital sodium (Nembutal)
c. Promethazine (Phenergan)
d. Secobarbital sodium (Seconal)
ANS: C
Phenergan is used as an adjunct to narcotic analgesics to potentiate pain relief, control anxiety, and reduce nausea. Hydroxyzine may have similar effects but is not given intravenously. Pentobarbital and secobarbital are used for anxiety only.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 802
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

6. The nurse is preparing a woman who is in labor for a lumbar epidural and explains that she will receive a continuous infusion of epidural anesthesia. She asks what will happen if that isnt effective. What response by the nurse is correct?
a. Increasing the amount of anesthesia will increase the risk of postdural headache.
b. You should tell the provider, and you may receive rescue doses of anesthesia if needed.
c. You will receive opioid analgesics if the epidural anesthesia is ineffective.
d. The consistent level provided by the continuous anesthesia will be sufficient.
ANS: B
Continuous epidural anesthesia provides a consistent drug level and more effective pain relief than with intermittent epidural anesthesia. Patients may have rescue doses as needed. Postdural headache occurs with accidental puncture of the dura with epidural anesthesia.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Pages 806-807
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

7. The nurse is assisting with placement of epidural anesthesia for a woman who is in labor. To help prevent maternal hypotension, which is the nurses initial action?
a. Administer 40 to 80 mcg of intravenous phenylephrine.
b. Infuse a bolus of 500 to 1000 mL of IV crystalloid solution.
c. Monitor the patients blood pressure closely during epidural placement.
d. Turn the patient onto her left side and give a rapid bolus of crystalloid solution.
ANS: B
To decrease maternal hypotension before epidural placement, an IV bolus of 500 to 1000 mL of crystalloid solution is given. When hypotension develops, the woman should be turned to her left side and administered a rapid bolus of crystalloid solution. Phenylephrine is given if hypotension does not improve. Blood pressure should be monitored throughout the procedure.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 811
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

8. The nurse is caring for a multipara woman during labor who has requested an epidural block. The nurse will tell the patient that the epidural block will be given when her cervix is dilated
a. 1 to 2 cm.
b. 3 to 4 cm.
c. 5 to 6 cm.
d. 7 to 8 cm.
ANS: B
In a multipara woman, an epidural block is given when the cervix is dilated 3 to 4 cm. In a primipara woman, the block is given at 5 to 6 cm.

DIF: COGNITIVE LEVEL: Remembering (Knowledge) REF: Page 813
TOP: NURSING PROCESS: Planning MSC: NCLEX: Reduction of Risk Potential

9. The nurse examines a primipara woman who has received an epidural block. The womans cervix has been dilated at 5 cm for an hour after having shown steady progression earlier. The nurse will notify the provider and anticipate a need for
a. caesarean section.
b. forceps delivery.
c. intravenous oxytocin.
d. vacuum extraction.
ANS: C
Regional anesthetics may slow labor, and therefore the patient may need to be administered a drug to enhance uterine contractions. Intravenous oxytocin is given to stimulate contractions. If oxytocin is not effective, the other measures may be necessary.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 816
TOP: NURSING PROCESS: Assessment/Planning
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

10. The nurse is caring for a patient after the third stage of labor, and the provider orders 20 mg of oxytocin to be given intramuscularly. The nurse will explain to the patient that this drug for which purpose?
a. To allow the cervix to close
b. To enhance milk letdown
c. To prevent uterine atony
d. To suppress lactation
ANS: C
After delivery of the infant, oxytocin is given to help the uterus stay contracted and prevent uterine atony. It may be given intravenously or intramuscularly. It does not constrict the cervix. Intranasal oxytocin may be given later to enhance letdown of breast milk. Oxytocin does not suppress lactation.

DIF: COGNITIVE LEVEL: Understanding (Comprehension) REF: Page 819
TOP: NURSING PROCESS: Nursing Implementation: Patient Teaching
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

11. The nurse prepares to assist with beractant (Survanta) administration to an infant who is intubated and mechanically ventilated. After removing the drug from the refrigerator, the nurse will perform which action?
a. Heat the drug in a warmer.
b. Discard the vial if the product appears light brown.
c. Shake the vial and draw up the drug dose.
d. Warm the vial by hand for 8 minutes.
ANS: D
Beractant (Survanta) should be given at room temperature and should be out of the refrigerator for 20 minutes to warm up or warmed in the nurses hand for 8 minutes. The drug should not be artificially warmed. The drug should not be shaken. The nurse may give off-white to light-brown product.

DIF: COGNITIVE LEVEL: Applying (Application) REF: Page 821
TOP: NURSING PROCESS: Nursing Intervention
MSC: NCLEX: Physiological Integrity: Pharmacological and Parenteral Therapies

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