Drugs affecting childbearing women and newborns Flashcards
(136 cards)
0
Q
When does the teratogenic period begin:
A
two weeks after conception
1
Q
Substances that causes developmental abnormalities are defined as:
A
teratogens
2
Q
How is iron to be used during pregnancy:
A
- Iron is vital to hemoglobin regeneration. only twice the normal requirement (18-30 mg) between the second and third semester
- The goal is to prevent maternal iron deficiency anemia, not to supply the fetus
- Supplementation w/iron is not necessary until second trimester
- The time of greatest demand is in third trimester of 22.4 mg/day d/t women having a decreased hematocrit
3
Q
What are the common side/adverse effects of iron:
A
N/V/D, constipation, black-tarry stools, GI irritation, epigastric pain (mostly GI related)
4
Q
What are the nursing implications/considerations when giving iron:
A
- 1: liquid forms can discolor teeth=dilute and give w/a straw
- Iron supplements are best absorbed on an empty stomach or w/water & juice 1 h before meals
- If GI irritation occurs, give with food
- iron should be administered 2 h before or 4 h after antiacids/levodopa/levothyroxine/methyldopa/penicillamine/quinolones/tetracyclines d/t iron inhibiting absorption of medications
- Foods rich in iron: liver, red meat, wheat germ, spinach, prunes
- Do not administer iron w/milk, cereals, tea, coffee, or eggs
5
Q
How is folic acid used during pregnancy:
A
- Part of preconception planning to improve outcomes of pregnancy d/t spontaneous abortion/birth defects/neural tube defects (leading to spina bifida/skull/brain malformations)/premature birth/premature separation of placenta
- Three approaches are recommended for child-bearing aged women (supplementation at 400-600 mcg, dietary fortification, food choices) d/t neural tube closure within the first 4 wks of pregnancy
- folate-rich foods are breads/flour/cornmeal/rice/pasta/cereals
6
Q
What are the side/adverse effects of folic acid:
A
Not common, but may occur as: allergic bronchospasm/rash/pruritus/erythema/general malaise
7
Q
How are prenatal vitamins used during pregnancy:
A
- prenatal vitamins generally provide A/D/C/B complex/B12/iron/Ca
- Role of prenatal vitamins in preventing congenital defects is UKN
- Megadoses of vitamins/minerals during pregnancy will not improve health and may cause harm to the fetus and the mother
- Most common reason for non-compliance is d/t iron causing N/V
- Be culturally aware. Eg: Pts from Mexico believe that taking vitamins is considered a “hot” food that should not be ingested during pregnancy
8
Q
Severe N/V that may require hospitalization to replace hydration and nutrition is defined as and what is given for Tx:
A
- hyperemesis gravidarum
- Reglan or Zofran may be given
- If a pt is experiencing 5% in weightloss when they should be ganing weight must be treated at a hospital immediately as it is life-threatening to the fetus (labs may see spilled keytones, low SG from urinalysis)
9
Q
What are some considerations when choosing a contraceptive method:
A
- Safety: not safe for everyone
- Protection from STI’s: when using a condom, not pills/injections…
- Effectiveness: if taken as should
- Convenience: depends on pt
- Acceptability: depends on knowledge/choice
- Education Needed
- Side Effects
10
Q
What are the types of contraceptives:
A
Hormonal & pharmacological
- OCP
- injections/implants
- IUD: intrauterine Devices
- Cervical rings
- transdermal patch
- Emergency contraception
11
Q
What effect of the estrogen and the progestrin have to prevent pregnancy when taking a combination OCP:
A
Estrogen:
- prohibits ovulation by preventing the formation of the dominant follicle
- stabalizes uterine endometrium to stop irregular bleeding
Progestrin
- Suppresses LH surge
- Decreases circulatory S/S
- Changes the landscape of the endometrium to make it less favorable for sperm implantation
- Causes the viscosity of the cervical mucous to be thick and hostile towards sperm
12
Q
What are the advantages of taking a COC pill:
A
- Shorter periods
- Decreased bleeding/uterine changes/PID (pelvic inflammatory diseas
- Decreased risks of ovarian/endometrial CA/osteoporosis
- Helps prevent ovarian cysts
- Decrease etopic pregnancy
13
Q
Why is the COC (Combintion) the most common birth control pill to take:
A
- High degree of effectiveness
- less side effects d/t the combination of estrogen and progestrin than the progestrin only pill
- Supresses pituitary release of LH and FSH
- Come in varying dosages: monophasic (A fixed ratio of estrogen to progestrin), biphasic (Estrogen is fixed, but progestrin varies), triphasic (both estrogen and progestrin varies)
14
Q
What does the progestrin “mini-pill” do:
A
- Interference of the endometrial lining causing implatation to be difficult
- Alters cervical mucosa making it thick nd viscous blocking sperm penetration
- Decreases perstalsis of the fallopian tubes slowing the transport of sperm
- Interferes w/LH surge inhibiting ovulation (only 50% of cycles)
- slightly less effective than the combination pill
- Should be taken 4-6 h before intercourse d/t the time it takes to alter the cervical mucosa to prevent sperm penetration
- If the mini pill is taken more than 3 h late, than a backup method should be used for 48 h
15
Q
Why is better to take a monophasic pill rather than a bi/triphasic pill:
A
- Monophasic pills provide a fixed amount of estrogen throughout the menstral cycle which increases the effectiveness in preventing pregnancies.
- The bi/triphasic pills provide varying doses of either estrogen or progestrin which cause less side effects, but won’t be as efective in preventing pregnancies d/t the varying amount of estrogen
16
Q
What are some drug interactions when taking OCPs:
A
The interaction of the following drugs decreases the effectiveness of the OCP. Have pts use a backup method for the duration of Tx and 7 days after
- anticonvulsants
- AntiTB meds: rifampin
- ABX
- barbiturates
- Hypnotics/sedatives
Drugs that may increase CHC activity:
- acetaminophen
- ascorbic acid
- fluconazole
Other Drug Interactions (use alternate means of contraception):
- anticoagulants: CHC increase clotting and decreases effectiveness of anticoagulants
- Anticonvulsants: CHC may increase SZ risks
17
Q
What are the contraindications to OCP (the absolute and the caution when using)
A
**Absolute Contrandications: **
Hx of
- BA/estrogen-dependent CA
- Thromboembolitic disorders/vascular disease
- Cerebrovascular/CVD
- Liver tumors
Other Absolute Contradications
- Pregnancy (known or suspected)
- Diabetic complications or diabetes >20 y
- UNK vaginal bleeding
- HTN 160/100 and above
- Heavy smoker or >35 ys
- Use of drugs that affect liver enzymes (anticoagulants, rifampin)
Caution
- >35 y &
- >40 yo
- Non-insulin dependent DM
- Controlled or mild HTN
18
Q
What are the side effects when taking OCP:
A
Excess estrogen effects:
- PMS like-S/S (N/V, edema, fluid retention, bloating, breast enlargement/tenderness), chloasma (hyper-pigmentation=brn spots near the eyes)
- Not so common ones: leg cramps, vascular HA, Visual changes, HTN
Excess Progestrin Effects:
- Increased appetite/weight gain, oily skin/scalp/acne, depression, vaginitis d/t yeast, hirsutism, decreased breast size, amenorrhea (absence of period)/spotting
19
Q
What can pts take when they are contraindicated for combination birth control:
A
These pts can take a progestrin mini pill, no estrogen pill
20
Q
What are the advantages in taking an alternative method to OCP:
A
- avoid GI absorption and therefore bypassing the “first-pass effect” of the liver
- Avoid OCP S/S like: N/V, blood clots, non-compliance
21
Q
What are the types of contraceptive hormonal injections and what are the frequencies, route, and side effects:
A
Depo-Provera (medroxy_progesterone (only_):
- A progestrin injection given once every 3 mo IM into either the deltoid or the ventrogluteal muscle, or subcut (anterior thigh or abd, should NOT be massaged after injection as it can decrease effectiveness); sideeffects include weight gain, spotting/irregular bleeding, depression (period may cease 1 y after), bone density loss (have pt take V-D and Ca and do weight bearing exercises)
Lunelle (combination)
- No info in books, monthly IM, assume combination side effects
22
Q
What implant contraceptive is given and what is its frequency, route, and side effects:
A
Implanon
- Single rod low-dose progesterin implant inserted in the subdermis of the upper inner arm which stays in place for 3 yrs
- side effect: 20% of women may have amenorrhea for the duration of the implant
23
Q
What is the frequency, route, and side effects of NuvaRing:
A
NuvaRing
- A soft, plastic ring inserted into the vagina for 3 wks and take out on the 4th week; administers both estrogen and progestin
- Side effects include expulsion, vaginal discharge, discomfor, can’t be worn by pts over 198 lbs, must be re-fitted if weight fluctuatest; if taken out for more than 3 hrs, backup is required until 7 days after new insertion of ring
24
What is the frequency, route, and side effects of IUD:
***_Intrauterine Devices_***
**Paraguard (copper)**
* Non-hormonal, sterile copper contraceptive inserted into the uterus and interferes with uterine contractions to prevent spermigration, causes inflammation of the endometrium, can be used as an emergency contraceptive; can stay for 10-12 years; **ideal for cardio pts**
* Side effects: increase blood loss/uterine cramping/flow by 35%, pelvic inflammatory disease may result within 20 days of insertion if sterile technique wasn't utilized, expulsion
**Hormonal Intrauterine Device (Mirena)**
* A progesterine IUD inserted into the uterus and stays in place for 5 years, typically given before closing up C-section; no severe side effects like the copper IU; perforation of the uterine wall; expulsion
25
What is the frequency, route, and side effects of the transdermal patch contraceptive:
**Transdermal Patch (Ortho-Evra)**
* A combined hormonal patch that is placed on dry, clean skin (not on the breasts/nor placed on creases) once for three weeks and taken off the fourth week for withdrawal bleeding;
* Side effects include: risk of VTE is greater d/t the higher absorption of estrogen from the patch then when compared to the OCPs, change in vision, skin irritation, menstral cramps, can't be worn if 198lbs or more
26
What are the types of emergency contraceptives and what are the frequencies, routes, and side effects:
**Levonorgestrel Plan-B**
* over the counter PO med (1 or 2 tabs), gives high levels of progestrin and can be taken 3 days after unprotected sex
**Ella **
* A Rx progesterone agonist/antagonist PO med (1 or 2 pills) that releases prostaglandins which promote contractions/shredding (exclude pregnancy before it's Rx), can be used within 5 days after unprotected sex
**Copper ( Paraguard) IUD**
* A copper IUD that can be inserted into the uterus within five days of unprotected sex
27
What are the types of barrier methods that can be used in place of hormonal or non-hormonal contraceptives:
Spermicides (Today Sponge is inserted and placed snugly against the cervix 24 h before sex and 6 hs after sex), diaphragm/cervical (requires medical insertion), male/female condom (protects against STIs & HIV)
28
What are the hormonal methods for combined estrogen and progestrin contraception:
* The pill
* Nuva Ring
* The patch (Ortho Evra)
* Lunelle (IM)
29
What are the hormonal methods that are progestrin only contraceptives:
* Mini-Pill
* IUD (Mirena)
* Depo-Provera
* Implanon
* EC: Plan-B and Ella
30
Sharon White, 19 yo, has just started taking birth control pills. She calls the nsg to say that her breasts are tender and she's nauseous. The nsg's response is based on knowledge that:
1. These are serious side effects
2. These effects usually decrease after 3-6 cycles
3. Taking the pill in the morning reduces side effects
4. Taking the pills every other day reduces side effects
2: These effects usually decrease after 3-6 cycles
31
What is the definition of class A drugs:
Studies in pregnant women show no risk
32
What is the definition of Class B drugs:
Studies in pregnant animals show no risk
33
What is the definition of Class C drugs:
Safety not determined in human pregnancy; animal studies show some risk or not done
34
What is the definition of Class D drugs:
Some evidence of risk in human pregnancy
35
What is the definition of Class X drugs:
Reports in humans and various studies in animal **show** risks
36
What three layers make up the uterine wall:
1. Perimetrium: outer
2. Myometrium: middle
3. Endometrium: inner
37
What triggers production of progestrin and estrogen:
Hypothalamus secretes Gn-RH which stimulates anterior pituitary gland to secrete FSH/LH which in turn stimulates ovary production of estrogen and progstrin
38
What does ACHES stand for that women on hormonal contraceptives should be aware of:
* A-bd pain (d/t liver/ovarian tumors)
* C-hest pain
* H-A (d/t poor perfusion, ICP)
* E-ye strain (blurred vision, can be S/S of pre-eclampsi)
* S-welling of legs (may mean inadequate kidney function r/t low albumin)
39
How does N/V affect pregnant mothers:
* Commonly experienced 88% during 1st semester
* Non pharmacologic methods i**nclude: crackers, any bland foods, flat sodas, taking vitamins/iron with food or before bedtime, ginger, eating small freqent meals and rising slowly, peppermint**
* **Drugs given for N/V is ondansetron (zofran), Reglan, or promethazine (Phenergan)**
* If methods of N/V are not relieved, **IV fluids or TPN (total parenteral nutrition) are necessary to prevent weight loss that may be life threatening to fetus**
40
What is the medical term for heartburn and how is it treated during pregnancy:
* Pyrosis is a burning sensation in the epigastric and sternal regions that occurs with reflux of acidic stomach contents occurs up to 80%
* The increase of progesterone during pregnancy causes decreased motility of the GI and relaxes the cardiac sphincter (between esophagus and stomach) making reverse perstalsis more likely and is aggravated when a pt lies or sits down right after eating
* Non-pharmacologic Tx: sm meals, eating slowly, avoid salty/greasy/citrus foods/gas-causing foods (onions, cabbage, beans)/avoid reclining imediately/drinking fluids after eating meals (not during)
* Pharmacological Tx: antiacids that are Na free (diabetic antiacids, tums, won't interfere w/electrolytes; **no alkaseltzer/maylox**) or ones that contain aluminum/Magnesium (**Amphojel/Mylanta**)
41
What type of pain may pregnant mothers experiene and how is pain tx:
* Upto 26 wks in of pregnancy, mothers will commonly experience **HA (d/t hormonal changes**), sinus congestion, **eye strain**, **back pain, joint pain, and ligament pain**
* Non-pharmacological methods are preferred: rest, relaxation exercises, mental imagery, ice packs/warm heat, correct body mechanics, style of footwear
* Pharmacologic Tx: only Acetaminophen (NO ASA-**platelets are unable to form clots/**inhibit or prolong labor, Ibuprofen-may cause premature closure of ductus arteriosus)
42
What is the goal in giving RhoGam to a what Rh type of mother who has a what Rh type fetus:
* We give RhoGam to Rh- mothers if they have a Rh+ fetus to prevent formations of antibiodies and to prevent erthroblastosis of Rh+ fetus.
43
How is RhoGam (rho D Immune Globulin) administerd, action, Route, Dose.
* RhoGam is administered to non-sensitized at 28 wks of gestational age and w/in 72 hrs after delivery/ectopic pregnancy/truama
* Administered IM (deltoid) at 300 mcg to promote destruction of Rh-positive fetal cells
* Considered to be a blood product from certain religious groups
44
Labor that occurs between 20-37 wks of pregnancy, involving a fetus with a weight of 500-2499 g is defined as:
Preterm Labor (PTL)
45
What are the contributing factors of PTL:
* Age of mom: \<18 or \>40
* intrauterine infections/UTI
* incompetent cervix
* hx of PTL \>risk
46
What are the initial measures in tx of PTL:
Non-pharmacological PTL measures:
* Hydration: \>8 glasses of fluids
* Rest: Pelvic rest (sex/douching) feet up,
* Decrease activity
* R/O uterine infection
47
Drug TX to decrease uterine muscle contraction is defined as:
Tocolytics
48
What makes a mother a candidate for tocolytics:
True preterm labor (PTL) will show change in cervix and show no S/S of contraindications are considered candidates of tocolytics
49
What are the tocolytic contrandications :
* \<20 wks of gestation via UZ
* Premature rupture of membrane (PROM) or bulging bag of water
* Fetal demise/severe compromise via UZ
* Maternal hemorrhage (d/t placental eruption)
50
What is the goal of tocolytics:
* Interrupt or inhibit uterine contractions to create additional time for fetal maturation
* delay delivery so antenatal corticosteroids can be delivered to facilitate fetal lung maturation
* allow safe transportation of the mother to be in an appropriate facility if required.
51
What are the type of tocolytics given for preterm labor (PTL)?
1. 2 Beta adrenergic agent
2. 2 Calcium tocolytics (antagonist and blocker)
3. Prostaglandin synthesis inhibitor
52
What are the two types of beta-adrenergic agents used for PTL (preterm labor) and what are the routes/action/side effects:
* ritodrine (Yutopar)
The only FDA approved beta-adrenergic drug for PTL to relax sm muscle of the uterine walls, but has significant consequences of cardiorespiratory system
* Terbutaline (Brethine)
Non-FDA approved beta-adrenergic drug that's suppose to be used for bronchospasms, but it's unlabled use is for PTL; typically given via subQ to relax the uterine muscle wall
* **Contraindicated in pts w/DM or cardiovascular disease**
* **Cardiovascular s/s: maternal/fetal tachycardia, palpations, dysrhythmias,** chest pain, wide pulse pressure
* **RR S/S: dyspnea, chest discomfor**t
* CNS: tremors, restlessness, weakness, dizziness, HA
* Metabolic S/S: hypokalemia, hyperglycemia
* GI S/S: N/V/reduced motility
53
What drug is giving for reversing the tachycardiac S/S of beta-adrenergics:
Propanol
54
What are the two types of Ca tocolytics given to antepartum pts w/PTl (preterm labor), and what are the routes, actions, S/S, and antedote (if any)
* **Mg sulfate (calcium atagonists)**
A Ca antagonist given for both PIH and PTL via IV. Its action is to relax the sm muscle of the uterine wall thru Ca displacement; S/S DTR **(use hammer to check for DTR to prevent S/S of RR/Cardiac deppression from occuring)**/cardiac/respiratory depression, lethargy, N/V, weakness, visual blurring
**Antedote given if Mg sulfate levels are too high**, **Calcium gluconate i**s given to reverse the S/S
* **nifedipine (Procardia) Ca channel blocker**
Procardia reduces muscle contraction of the uterine wall by blocking Ca channels via PO; S/S **flushing, maternal/fetal HR increase (\>120 BPM should be reported), & orthostatic hypotension** (sit/stand slowly) d/t procardia being a vasodilator
55
What prostaglandin tocolytic is given for PTL preterm labor and what is the route, S/E, and action?
* **Indomethacin (Indocin) prostaglandin synthesis inhibitor**
Indocin inhibits prostaglandins from inducing uterine contractions via oral does. S/E epigastric pain, nausea, G.I. bleeding, increased BP in HTN pts, fetus constriction of ductus arteriosus. decreased amniotic fluid
56
What is the goal of giving corticosteroids to preterm labor patients?
* Administration of corticosteroids **accelerates lung maturation and lung surfactant development in the fetus, thereby decreasing incidence and severity of respiratory distress syndrome (RDS) and intraventricular hemorrhage (IVH)** in neonates
57
What are the types of corticosteroids given to patients with preterm labor and what are the side effects, route, and action?
* **Betamethasone corticosteroid**
A corticosteroid given in IM 2 doses preterm labor pts before delivery. Contraindicated in severe gestational HTN; L/S ratio must be determined prior to administration; S/E p**ulmonary edema (report of chest pain/difficulty breathing)**, increase bld glucose, nervousness, insomnia
* **Dexamethasone corticosteroid**
dexamethasone is the same as above.
58
If L/S ratio was 2:1, would corticosteroids be given to a PTL patient?
NO, as 2:1 ratio determines the fetus's RDS and lung maturation is WNL
* Side note: L/S = lecithin/sphingomyelin)
59
What is the difference between preeclampsia versus eclampsia and what does it have to with gestational hypertension (PIH)?
* **eclampsia**: grand mal seizures in patients with preeclampsia
* **Preeclampsia (\>140/\>90 w/proteinuria of \>300 mg):** is pregnancy induced hypertension **with proteinuria** that causes massive vasospasms (pulmonary edema, dyspnea, vasoconstriction of cerebral vessels leads to HA and visual disturbances) that causes decreased perfusion to placenta
* **Gestational hypertension or pregnancy induced hypertension (PIH): **is elevated blood pressure **without proteinuria** after 22 gestational weeks in pts
60
What are some common risk factors of preeclampsia?
* Extreme maternal age, African-American, obesity, maternal DM, chronic HTN/ Renal disease, positive family history of hypertension/DM.
61
What are the common signs of preeclampsia?
* HTN and generalized edema (face, stomach, extremities, ankles)
* precursors for eclampsia: continuous HA, mental confusion, visual disturbances, blurred or double vision, and epigastric pain or upset stomach which indicates SZ
62
What are the treatments for preeclampsia and eclampsia?
* Delivery
* magnesium sulfate
* 2 anti-– HTN
63
What's anti-convulsant is used to Tx eclampsia and what is the route, action, and side effects
* Magnesium sulfate
prevent seizures by acting as a CNS depressant smooth muscle relaxant via IV; side effects include depressed DTR/RR, hypotension, flushing; antidote is calcium gluconate
64
When would anti-hypertensive medicine be given to a preeclampsia patient, and what is that action, route, and side effects:
* Systolic BP \>160
* **hydralazine (Apresoline**-drug of choice)
A vasodilators that decreases BP via IV; S/E maternal tachycardia and increase cardiac output
* **Methyldopa (Aldomet)**
Decreases sympathetic outflow to heart, kidneys, peripheral vasculature via IV or PO
65
The NSG administers betamethasone to a PTL patient. The NSG knows that the client understands pt education if the patient states, "this medication will help my baby's lungs mature," and what else?
1. And is effective within 24 hours enough to one week.
2. if I remain in bed for the next six weeks on my L side
3. if I take my medicine at the same time every day
4. if I avoid sexual intercourse for the remainder of my pregnancy
3: if I take my medicine at the same time every day
66
What drug is given to a pregnant patient that is Rh negative:
1. RhoGam
2. rubella vaccine
3. hepatitis B vaccine
4. Motrin
1: RhoGam
67
A nsg is teaching a patient how best to decrease G.I. distress she experiences with her prenatal vitamins. The nsg igives the patient which instructions for taking prenatal vitamins?
1. Take the vitamins between meals
2. Take the vitamins with food
3. take the vitamins with orange juice
4. take the vitamins with milk
2: take the vitamins with food
68
The nsg advises the patient to take which supplement for at least three months before becoming pregnant prevent fetal neural tube defects?
1. Iron
2. ginger
3. folic acid
4. B6
3: folic acid
69
A patient with severe preeclampsia is on magnesium sulfate. Her labs report a magnesium level of 7 mEq per liter. Which would be the nsg's best initial action?
1. Continue to monitor the patient has this level is therapeutic.
2. Report level of magnesium to MD.
3. Prepared to administer 1 g of calcium gluconate.
4. Turn patient to L side and administer 10 L of O2 via nasal cannula.
1: magnesium levels are within normal limits (4 – 7)
70
What is the first sign of magnesium toxicity in a PTL patient:
1. Lethargy
2. RR \<12/min
3. loss of patellar reflexes
4. positive clonus
3: Loss of patella reflexes
71
If patient has been receiving magnesium sulfate IV for 24 hours cheat severe preeclampsia. On assessment the patient's temperature is 37.3 Celsius, pulse 88, respirations 14, BP 138/76, 21 patellar reflexes, a negative ankle clonus. What is the priority intervention?
1. Obtain Stat magnesium sulfate level
2. discontinue magnesium sulfate IV
3. continue to monitor
Patient shows no signs of magnesium sulfate toxicity. continue to monitor.
72
19-year-old patient with primigravida is at 8 gestational weeks, is taking her first examination. She c/o of nausea and vomiting every morning. Which comment made by the patient would indicate need for further instruction?
1. My friend gave me gingersnap cookies to eat
2. I have been eating dry crackers before I get up
3. I have tried to avoid foods with strong smells
4. I have been drinking chamomile tea every day
4: I have been drinking chamomile tea every day
73
Dictation is planning to become pregnant. Which action should she initiate before she stops taking her OCP? Select all that apply.
1. Stop smoking
2. take omega six fatty acids everyday
3. take a multivitamin every day
4. stop taking over-the-counter acetaminophen
5. contact healthcare provider
Stop smoking, take a multivitamin every day, see healthcare provider.
74
What are the types of pain management drugs given for the intrapartum period?
There are types of systemic drugs.
1. Narcotic agonist
2. mixed Narcotic agonist
3. sedative/hypnotics
4. antagonist which would be a Narcan
75
What are the two narcotic agonist given for pain management in the intrapartum period, and what is the route, action, and side effects?
* **Morphine sulfate (not commonly given)**
An opioids that is a CNS depressant via IV or IM, main side effect is respiratory depression/palpations
* **Meperidine (Demerol; most commonly given)**
same as above
* t**he antidote for adverse effects of morphine or Demerol is narcan**
76
What are the 2 mixed narcotic agonist given to patients in the intrapartum period for pain management and what is the route, action, S/S?
* **Butorphanol (Stadol-given** **if cervix is at 8 cm**)
An opioid drug that acts as a CNS depressant via IV; s/S **newborn respiratory depression or bradycardia**, maternal S/S N/V, clamminess, sweating, RR depression, vertigo, HA, and flushing; **Antedote is Narcan**
* **Nalbuphine (Nubain)**
same as above
77
What are the two sedative/hypnotics used for patients and intrapartum period and what is the route, action, side effects:
* **Promethazine (phenergan) and ****Hydroxyzine (Vistaril)**
an anti-anxiety and antiemetic may be commonly given w/a narcotic like Demerol via IV/IM; helps to potentiate the effects of Demerol/narcotics, S/S decreased FHR, neonatal RR depression, decreased sucking
78
When would general anesthesia be necessary for pain management in the intrapartum period:
* General anesthesia is necessary for emergency deliveries, when spinal or epidural anesthesias are contraindicated.
* Before administering general anesthesia, antiacids will be administered to decrease complications from gastric acid aspiration
79
What are some nonpharmacological ways of controlling pain during labor?
* Ambulation, supportive positioning of the gravid uterus and promotion of uterine perfusion, touch and massage, hygiene and comfort measures, support persons, breathing and relaxation techniques, hypnosis, hydrotherapy
80
What are the type of regional pain management for controlling labor pains:
* Epidural
Prehydrate w/LR or NS; displace uterus manually w/wedge placed under pt's side to enhace placental perfusion; assess hypotension 5-15 min; report if BP is \<110/pallor/diaphoresis/bra
* Combine spinal – epidural CSE
81
What is the fluid replacement for pts w/hyperemesis Gravidarum:
TPN (white bag): total parentaral nutrtion w/glucose (give water to help dilute high glucose levels
82
What type of labs would I expect in a pt with hyperemesis gravidarum:
Decreased UO, increased SG/HCT/Hgb
83
What are the uterotropic drugs given for induction and augmentation of labor:
* Prostaglandin: causes cervical ripening
* Oxytocin: arguments after the induction of PG
84
Because prostaglandins causes cervical ripening, what are the two types of PG drugs given for inducement of labor:
Two Cs (gel intracervix)
* Cytotec
* Cervadil
85
What is a contraindication of oxytocin given for augmentation of labor:
Increasing hemorrhage
86
What are some NSG interventions before administering anesthesia:
* hydration status (500 to 1000 mL)
* Foley catheter
* Patient should be positioned and supported on left side
* Monitor maternal vital signs and FHR
* Treat maternal hypotension due to uterine displacement by placing a wedge under hip
* Trendelenburg position is when the feet are above head level
87
What drugs are given for postpartum hemorrhage and what do these drugs do:
* Oxytocin/Pitocin/Ergotrate
* Methergine
* prostaglandin
Stimulates smooth muscles to sustain contractions in order to get rid of the uterus
88
What is given to relieve perineal wounds:
Benzocaine (spary on after using a peribottle)
89
What is given to relieve perineal hemorrhoids:
Hydrocortisone and Proctofoam – HC
90
How do you promote BM during postpartum
Fruit, hydration, ambulation
91
What medications are given to really born infants
Vitamin K (phytonadione, IM in vastus lateralis), triple dye, Erythromycin eye ointment
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When endometrial tissue extends beyond the uterus causing a retroflux of menstral flow in the fallopian tubes which creates deep, uni/bilateral chronic, cyclic pain and infertility is defined as:
endometrioses
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The treatment of endometriosis with either Danzol or the two (Gn\_RH) acetates will cause what type of action:
* The testoseterone **Danzole** and the **two (Gh-RH) acetates** will cause a **pseudomenopause** effect d/t interfereing w/estrogen production
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What is a Tx for endometriosis that INHIBITS ALL estrogen production from the body:
**Aromatase inhibitor: Arimidex**
Side note: bone loss w/long term use
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What type of surgeries are done to help tx endometriosis:
hysterectomy or laproscopy
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What are the types of meds given for endometriosis:
ibuprofen
progestrin
aromatase inhibitor (arimidex)
Testosterone (danazol)
Gn-RH agonist (lue/na acetates)
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What are the Tx for PMS:
OCPs
Antidepressants
dietary
stress reduction
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What are the stages of menopause:
1. Premenopause (up to 5 y w/irregular mensus, hotflashes, vaginal dryness)
2. Menopause: no mensus for 1 y
3. Post menopause: taking hormonal meds
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What are some S/S of a hypoestrogenic state:
Irregular mensus, nervousness, vaginal dryness, vasodilation=hot flashes, decreased bone mass
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If a post menopause women is on estrogen, what other hormone should she take as well:
progestrin d/t excess estrogen causing endometrial/uterine CA unless surgery was done
Combination of estrogen and progestrin increases BrCA
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How many calories/protein needed during pregnancy
80,000 calories/25 g of protein/day needed during pregnancy
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To reduce the incidence of neural tube defects such as spina bifida, women of childbearing age are recom- mended to consume:
a. at least 0.4 mg folic acid per day in foods and supplements.
b. 300 extra calories near the expected conception date.
c. 60 mg of supplemental iron, in addition to high- iron foods.
d. two added servings of foods high in vitamin C.
a. at least 0.4 mg folic acid per day in foods and supplements.
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Choose the correct nursing teaching about a woman’s iron supplement during pregnancy.
a. Take the iron 30 minutes before the first food of the day.
b. Taking the iron with dairy foods will reduce the gastric side effects.
c. Stools are somewhat loose and are lighter brown than usual.
d. A food high in vitamin C may enhance absorption of iron.
d. A food high in vitamin C may enhance absorption of iron.
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A calcium supplement is best taken:
* a. with high-iron foods.
* b. at bedtime
* c. with meals.
* d. upon arising.
with meals
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When teaching an adolescent about nutrition during pregnancy, the nursing approach should:
a. focus on the girl’s responsibility to her fetus.
b. provide as many choices as possible from nutritious foods.
c. ask the girl to limit snacking and fast foods.
d. explain how a good pregnancy diet will promote her health.
b. provide as many choices as possible from nutritious foods.
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Choose the correct nursing approach regarding caffeine use during pregnancy.
a. Teach that caffeine has not been shown to be a risk.
b. Limit total intake of caffeine-containing drinks to four daily.
c. Discuss sources of caffeine in addition to coffee and tea.
d. Drink one additional glass of plain water for each caffeine-containing drink.
c. Discuss sources of caffeine in addition to coffee and tea.
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A non–breastfeeding woman is anxious to lose weight after birth. Which nursing education is most appropri- ate?
a. She may begin dieting immediately because she is not breastfeeding.
b. She should consume a minimum of 1800 calories each day to maintain energy.
c. She should take her prenatal vitamin-mineral supplement while dieting.
d. She should wait at least 3 weeks before beginning a diet
d. She should wait at least 3 weeks before beginning a diet
108
Under what two circumstances should butorphanol (Stadol) or nalbuphine (Nubain) not be given to a woman in labor
These drugs have combined opioid agonist-antagonist effects and should not be given to a woman who has had a recent dose of a pure opioid agonist (may reverse effective- ness of first drug) or to a woman who is addicted to opiates such as heroin (may precipitate acute withdrawal).
109
List methods to relieve pain of a postspinal headache.
bed rest with oral or intravenous hydration; blood patch
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Firm sacral pressure is likely to be most helpful in which situation?
a. Rapid labor and birth b. Fetal occiput posterior position c. Oxytocin induction of labor d. If analgesics should be avoided
b. Fetal occiput posterior position
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A woman receives meperidine (Demerol) during labor. Because this analgesic is being used, the nurse should have on hand:
a. butorphanol (Stadol). b. lidocaine (Xylocaine). c. nalbuphine (Nubain). d. naloxone (Narcan).
d. naloxone (Narcan).
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When stocking a cart for epidural analgesia, the most important nursing action is to:
a. add additional bags of intravenous (IV) normal saline.
b. place anticoagulant drugs to allow rapid access. c. verify that no epidural drugs have preservatives. d. provide an indwelling catheterization tray
c. verify that no epidural drugs have preservatives.
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The appropriate nursing action for a woman who has a postspinal headache is to:
a. keep her bed in a semi-Fowler’s position. b. encourage intake of fluids that she enjoys. c. have her ambulate at least every 4 hours. d. restrict intake of high-carbohydrate foods.
b. encourage intake of fluids that she enjoys
114
Choose the primary distinction between threatened and inevitable abortion.
a. Presence of cramping b. Rupture of membranes c. Vaginal bleeding d. Pelvic pressure
b. Rupture of membranes
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A woman is admitted to the emergency department with a possible ectopic pregnancy. Choose the sign/ symptom that should be immediately reported to her physician.
a. Low level of b-human chorionic gonadotropin (b-hCG)
b. Hemoglobin of 11.5; hematocrit of 34% c. Light vaginal bleeding d. Pulse increase from 78 to 100bpm
Pulse increase from 78 to 100bpm
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The woman who is receiving methotrexate for an ectopic pregnancy should be cautioned to avoid:
a. driving or operating machinery. b. eating raw vegetables or fruits. c. using latex condoms for intercourse. d. taking vitamins with folic acid.
d. taking vitamins with folic acid.
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A woman who is 34 weeks pregnant is admitted with contractions every 2 minutes, lasting 60 seconds, and a high uterine resting tone. She says she had some vaginal bleeding at home, and there is a small amount of blood on her perineal pad. The priority action of the nurse is to:
a. establish whether she is in labor by performing a vaginal examination.
b. ask her whether she has had recent intercourse or a vaginal examination.
c. evaluate the maternal and fetal circulation and oxygenation.
d. determine whether this is the first episode of pain she has had.
c. evaluate the maternal and fetal circulation and oxygenation.
118
Nursing teaching for the woman who has hyperemesis gravidarum should include:
a. adding favorite seasonings to foods while cooking.
b. eating simple foods such as breads and fruits. c. lying down on the right side after eating. d. eating creamed soup with every meal
b. eating simple foods such as breads and fruits
119
The nurse makes the following assessments on a woman who is receiving intravenous magnesium sulfate: FHR 148 to 158 bpm, pulse 88 bpm, respirations 10 breaths/min, blood pressure 158/96mm Hg. The priority nursing action is to:
a. increase the rate of the magnesium infusion.
b. maintain the magnesium infusion at the current rate.
c. slow the rate of the magnesium infusion. d. stop the magnesium infusion.
d. stop the magnesium infusion.
120
When providing intrapartal care for the woman with severe preeclampsia, priority nursing care is to:
a. maintain the ordered rate of anticonvulsant medications.
b. promote placental blood flow and prevent maternal injury.
c. give intravenous fluids and observe urine output.
d. reduce maternal blood pressure to the prepregnancy level.
b. promote placental blood flow and prevent maternal injury.
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Clonus indicates that the:
a. central nervous system is very irritable. b. renal blood flow is severely reduced. c. lungs are filling with interstitial fluid. d. muscles of the foot are inflamed.
a. central nervous system is very irritable.
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The feature that distinguishes preeclampsia from eclampsia is the:
a. amount of blood pressure elevation. b. edema of the face and fingers. c. presence of proteinuria. d. onset of convulsions.
d. onset of convulsions.
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Which woman should receive RhO(D) immune globulin after birth?
a. Rh-negative mother; Rh-positive infant; positive direct Coombs test
b. Rh-positive mother; Rh-negative infant; negative direct Coombs test
c. Rh-negative mother; Rh-positive infant; negative direct Coombs test
d. Rh-positive mother; Rh-positive infant; positive direct Coombs tes
c. Rh-negative mother; Rh-positive infant; negative direct Coombs test
124
An infant weighing 8 pounds 10 ounces is born vagi- nally. Shoulder dystocia occurred at birth. Because of this problem, the nurse should assess the infant for:
a. head swelling that does not extend beyond the skull bone.
b. inward turning of the feet and/or legs. c. creaking sensation when the clavicles are palpated. d. limited abduction of one or both hips.
c. creaking sensation when the clavicles are palpated.
125
A woman is receiving magnesium sulfate to stop preterm labor. The essential nursing assessment related to this drug is:
a. for frequency and duration of uterine contractions.
b. hourly vital signs, heart sounds, and lung sounds.
c. for presence of fetal movements with contractions.
d. vaginal examination for cervical dilation, effacement, and station.
b. hourly vital signs, heart sounds, and lung sounds.
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Choose the nursing assessment that most clearly suggests hypovolemia.
a. Urine output of 20 to 25 ml/hr b. Fetal heart rate of 155 to 165 bpm c. Blood pressure of 108/84mm Hg d. Maternal heart rate of 90 to 100 bpm
a. Urine output of 20 to 25 ml/hr
127
Which woman would be a good candidate for the hormone contraception?
a. A 30-year-old woman who thinks she has completed her family
b. A 22-year-old breastfeeding woman who just gave birth
c. A 29-year-old woman who has type 2 diabetes secondary to obesity
d. A 25-year-old woman who takes an anticonvulsant
a. A 30-year-old woman who thinks she has completed her family
128
A to Depo-Provera. Her last menstrual period ended 1 week ago. She should be taught that she should:
woman decides to change from the diaphragm
a. take the oral contraceptive during this cycle only.
b. return in 1 week to have the hormone injection.
c. continue to use the diaphragm for the rest of her cycle.
d. expect heavier periods than she had when using the diaphragm.
c. continue to use the diaphragm for the rest of her cycle.
129
How should a woman take oral contraceptives?
a. On an empty stomach, with a full glass of water b. At about the same time each day c. Before every episode of intercourse d. In the morning and at bedtime
b. At about the same time each day
130
# Choose the safety teaching related to oral contraceptives.
a. A barrier method should also be used to protect from infection.
b. Nausea suggests that stroke may be imminent.
c. Toxic shock syndrome is more likely to occur when the pill is used.
d. Increase fluids if urinary frequency or urgency occurs
a. A barrier method should also be used to protect from infection.
131
The IUD is an appropriate contraceptive for the woman who:
a. has unplanned intercourse with several partners.
b. was recently hospitalized for treatment of a pelvic infection.
c. is in a mutually monogamous relationship. d. has had two ectopic pregnancies.
c. is in a mutually monogamous relationship.
132
If the IUD strings are longer than usual, the woman should:
a. know that this is expected when the IUD is first inserted.
b. immediately have a Pap smear to rule out cervical cancer.
c. take her temperature twice a day for 1 week.
d. see her physician and use another method of contraception.
d. see her physician and use another method of contraception.
133
To relieve her menstrual cramps, a woman should be taught to take ibuprofen:
a. within 8 hours of the onset of menstruation.
b. before onset of menstruation and cramps.
c. every 4 hours during the 2 days preceding menstruation.
d. on an empty stomach before the pain becomes severe.
b. before onset of menstruation and cramps.
134
Your friend is having hot flashes as she enters meno- pause. She is interested in hormone replacement to improve these symptoms but is fearful of breast can- cer. As a nurse, you should tell her that:
a. her physician or nurse-practitioner can evaluate her actual risk and help her make a better decision.
b. the risk of breast cancer is very small for women who are younger than the age of 60 when menstrual periods stop.
c. taking the estrogen with progestin will reduce the risk for estrogen-induced breast cancer.
d. the benefits of estrogen replacement therapy far outweigh any risks associated with it
a. her physician or nurse-practitioner can evaluate her actual risk and help her make a better decision.
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