Question 1

A nurse is teaching a class to a group of pregnant patients. The nurse correctly teaches that the highest risk of teratogen-induced gross malformations exists during which time?&#10;A) Immediately before conception&#10;B) During the first trimester&#10;C) During the second trimester&#10;D) During the third trimester

Accepted Answer

Gross malformations are caused by exposure to teratogens during the embryonic period, which is considered the first trimester. This is the time when the basic shape of internal organs and other structures is established. No risk exists immediately before conception unless the medication is a category X drug. Teratogen exposure during the second and third trimesters usually disrupts function rather than gross anatomy.

Question 2

A breast-feeding patient must take a prescription medication for 2 weeks. The medication is safe, but the patient wants to make sure her baby receives as little of the drug as possible. What will the nurse tell the patient?

A) To give the baby formula as long as the mother is taking the medication
B) To take the medication immediately after breast-feeding
C) To pump breast milk and feed the baby by bottle
D) To take the medication 1 hour before breast-feeding

Accepted Answer

Taking the medication immediately after breast-feeding minimizes the drug concentration in the breast milk at the next feeding. Disrupting breast-feeding is not indicated. Pumping the breast milk will not diminish the drugs or drug concentration in the breast milk. Taking the medication 1 hour before breast-feeding will increase concentrations of the drug in the breast milk.

Question 3

A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage?&#10;A) They may need to be given in higher doses if they undergo renal clearance.&#10;B) They require lower doses if they are metabolized by the liver.&#10;C) They are less likely to cross the placenta and affect the fetus.&#10;D) They are more likely to cause anatomical defects if they are teratogenic.

Accepted Answer

In the third trimester, drugs excreted by the kidneys may have to be increased, because renal blood flow is doubled, the glomerular filtration rate is increased, and drug clearance is accelerated. Hepatic metabolism increases, meaning that drugs metabolized by the liver must be increased. All drugs can cross the placenta. Anatomic defects are more likely to occur in the embryonic period, which is in weeks 3 through 8 in the first trimester.

Question 4

A patient has just given birth to a baby boy with a cleft palate. The nurse will review the patient's medication history with special emphasis on drugs taken during which period?&#10;A) Before she became pregnant&#10;B) During the first trimester&#10;C) During the second trimester&#10;D) During the third trimester

Accepted Answer

Gross malformations typically are the result of teratogens consumed during the first trimester. Using teratogenic drugs before becoming pregnant is a risk because 50% of pregnancies are unintended, and a patient could become pregnant while taking the drug. Exposure to teratogens during the second or third trimester usually alters function, not gross anatomy.

Question 5

A pregnant patient in active labor is admitted to the emergency department. A toxicology screen and a physical assessment reveal that the patient is an active heroin addict. The nurse who cares for the neonate after delivery should anticipate which clinical manifestation(s)?

A) Passivity and flat affect
B) Diarrhea and salivation
C) A shrill cry and irritability
D) Continuous restless sleep

Accepted Answer

The newborn of an active heroin addict experiences a withdrawal syndrome that includes shrill crying, vomiting, and extreme irritability. The newborn will not experience passivity or a flat affect, diarrhea or salivation, or continuous restless sleep as a result of being born to an active heroin addict.

Question 6

A patient in her second trimester of pregnancy tells the nurse she is worried that a medication she took before knowing she was pregnant might have harmed the fetus. What will the nurse do?&#10;A) Ask the patient what she took and when she learned she was pregnant.&#10;B) Contact the patient's provider to request an ultrasound.&#10;C) Counsel the patient to consider termination of the pregnancy.&#10;D) Suggest to the patient that she go to a high-risk pregnancy center.

Accepted Answer

When a pregnant patient is exposed to a known or potential teratogen, the first step is to find out when the drug was taken and when the pregnancy began to determine whether the drug was taken during the period of organogenesis, when the fetus is most vulnerable to teratogenic effects. If exposure occurred during this phase, the provider may order an ultrasound. Counseling the patient to terminate a pregnancy is not a nursing role. Until more is known about this patient's fetus, it is not necessary to refer her to another pregnancy center.

Question 7

A nurse is caring for a patient and her newborn immediately after delivery. The patient's medication history includes prenatal vitamins throughout pregnancy, one or two glasses of wine before knowing she was pregnant, occasional use of an albuterol inhaler in her last trimester, and intravenous morphine during labor. What will the nurse expect to do?

A) Administer opioids to the infant to prevent withdrawal syndrome.
B) Monitor the infant's respirations closely and prepare to administer oxygen.
C) Note a high-pitched cry and irritability in the infant.
D) Prepare the patient for motor delays in the infant caused by the alcohol use.

Accepted Answer

Narcotics given for pain during labor cross the placenta and can cause respiratory depression in the infant. Nurses must be prepared to provide respiratory support and to give naloxone to reverse the narcotic effects if necessary. Exposure to opioids during labor is not sufficient to cause dependence, so withdrawal syndrome is not an issue. Infants withdrawing from drugs have a high-pitched cry and are irritable, which is not expected in this case. Any drug taken during the first weeks of pregnancy tends to have an "all or none" effect, meaning that they either cause death of the conceptus or, if sublethal, the conceptus recovers.

Question 8

Which type of drug taken by a pregnant patient is more likely to have effects on a fetus?&#10;A) Drug that is highly polar&#10;B) Ionized drug&#10;C) Lipid-soluble drug&#10;D) Protein-bound drug

Accepted Answer

Lipid-soluble drugs cross the placenta more readily. Drugs that are highly polar, ionized, or protein bound cross the placenta with difficulty.

Question 9

A patient who has just learned she is pregnant has stopped using a prescription medication that she takes for asthma because she doesn't want to harm her baby. What will the nurse tell her?&#10;A) That asthma medications will not affect the fetus&#10;B) That her baby's health is dependent on hers&#10;C) To avoid taking medications during her pregnancy&#10;D) To resume the medication in her second trimester

Accepted Answer

Asthmatic women who fail to take medication have a doubled risk of stillbirth; therefore, the nurse should encourage the patient to use her medications. Because the health of the fetus depends on the health of the mother, all drugs must be considered in light of the benefits of treatment versus the risks to the fetus. Asthma medications may have effects on the fetus, but the risk of stillbirth presents a greater risk. In this case, the patient needs to take the medication to treat her asthma and not wait until the second trimester.

Deck 9: Drug Therapy During Pregnancy and Breast-Feeding