Question 1

A patient in preterm labor is receiving intravenous magnesium sulfate at a rate of 1 gm/hr. The woman reports headache and dizziness. Her blood pressure is 90/60 mm Hg. What will the nurse do?&#10;A) Ask her whether she has a history of myasthenia gravis.&#10;B) Expect the development of paralytic ileus.&#10;C) Stop the infusion and request an order for a diuretic.&#10;D) Tell the patient not to get up without assistance.

Accepted Answer

Initial reactions to magnesium sulfate include transient hypotension, headache, and dizziness. Telling the patient to ask for assistance when ambulating is appropriate. The patient's signs are not associated with myasthenia gravis, which is a contraindication to treatment with magnesium sulfate. A history of myasthenia gravis should be part of the pretreatment assessment. High doses of magnesium sulfate may cause paralytic ileus, but this patient is receiving a low dose. This patient does not have signs of fluid retention.

Question 2

A pregnant patient is 1 week post-term and will receive intravenous oxytocin. Which will the nurse evaluate before starting the infusion? (Select all that apply.)&#10;A) Cervical ripening&#10;B) Fetal monitoring&#10;C) Renal function&#10;D) Respiratory function&#10;E) Uterine activity

Accepted Answer

Before labor can be safely induced, cervical ripening must occur. Baseline data must include full maternal and fetal status. Maternal renal function and respiratory function are not part of the baseline assessment.

Question 3

A pregnant patient is being induced with oxytocin, which has been infusing for 1 hour. The initial rate was 6 milliunits/min, and the rate now is 18 milliunits/min. The nurse notes regular contractions occurring every 3 minutes, each lasting 35 seconds. The nurse will:

A) increase the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes.
B) increase the rate of infusion by 3 to 6 milliunits/min every 15 to 40 minutes.
C) interrupt the infusion and continue to monitor the patient before restarting.
D) interrupt the infusion and notify the provider of potential oxytocin toxicity.

Accepted Answer

This patient is being induced with a high-dose regimen of oxytocin, which starts at 6 milliunits/min and is increased by 3 to 6 milliunits/min every 15 to 40 minutes. The frequency and rate of her contractions are within normal limits, so the nurse can continue to increase the rate by 3 to 6 milliunits/min every 15 to 40 minutes until contractions last longer than 1 minute or occur more frequently than every 2 to 3 minutes. Increasing the rate of infusion by 1 to 2 milliunits/min every 15 to 40 minutes is part of the low-dose regimen. Because the frequency and duration of contractions have not reached optimum level, there is no need to interrupt the infusion. There are no signs of oxytocin toxicity.

Question 4

A postpartum patient is receiving ergonovine maleate (Ergotrate) to prevent hemorrhage. The nurse assesses the patient and notes a heart rate of 76 beats per minute, a respiratory rate of 16 breaths per minute, and a blood pressure of 120/80 mm Hg. The patient's uterus is firm. The patient complains of mild to moderate cramping. Bleeding is minimal. What will the nurse do?

A) Continue to monitor and tell the patient to report increased cramping.
B) Notify the provider of possible uterine hypertonicity.
C) Notify the provider of the patient's blood pressure.
D) Request an order to administer the Ergotrate intravenously.

Accepted Answer

This patient is showing signs of a desired response to the drug, so the nurse should continue to monitor. Increased cramping may be a sign of overdose, so the patient should know to notify the nurse if this occurs. A firm uterus with minimal bleeding is the desired effect. The blood pressure is within normal limits. There is no indication for giving this drug intravenously, because that method poses significant risks and is indicated only with severe hemorrhage.

Question 5

A patient has received two doses of dinoprostone (Prepidil) to initiate labor. It has been 6 hours since the last dose. The nurse assesses the patient and notes that the cervix is ripe and dilated to 4 cm, but contractions are diminishing in intensity and frequency. What will the nurse expect to do?

A) Administer oxytocin.
B) Monitor urine output.
C) Prepare for a cesarean section.
D) Watch closely for fetal distress.

Accepted Answer

Once the cervix is ripe and labor has occurred, labor should progress, with contractions increasing in duration and frequency. This woman is showing signs of stalled labor and, because the cervix is ripe, can be induced with oxytocin. Large doses of oxytocin can cause water intoxication, which is not a risk at this point in this patient. There is no indication for a cesarean section at this point. The risk of fetal distress is not increased at this point.

Question 6

Which are indications for early induction of labor? (Select all that apply.)&#10;A) Abruptio placentae&#10;B) Active genital herpes infection&#10;C) Gestational hypertension&#10;D) Premature rupture of the membranes&#10;E) Umbilical cord prolapse

Accepted Answer

Indications for early induction of labor include abruptio placentae, gestational hypertension, and premature rupture of the membranes. Active genital herpes infection and umbilical cord prolapse are contraindications to induction, even at term, because they can involve significant harm to the fetus.

Question 7

A nurse provides teaching to a woman who is taking tranexamic acid (Lysteda) for menorrhagia. Which statement by the patient indicates a need for further teaching?&#10;A) &#34;I may experience back pain or muscle cramps while taking this drug.&#34;&#10;B) &#34;I may take two tablets 3 times daily for up to 5 days with each period.&#34;&#10;C) &#34;I should take an oral contraceptive to prevent pregnancy while taking this drug.&#34;&#10;D) &#34;I should take this medication with food to improve absorption of the drug.&#34;

Accepted Answer

The greatest concern with tranexamic acid (TA) is venous or arterial thrombosis. Women taking TA should not take oral contraceptives, which would increase the risk of thrombosis. Back pain and muscle cramps are known adverse effects. Women may take up to two tablets 3 times a day for up to 5 days with each period. The medication can be taken with or without food, but bioavailability increases in the presence of food.

Question 8

A patient who is having her sixth child has gone beyond term, and her labor is being induced with oxytocin (Pitocin). The patient is having increased frequency, duration, and intensity of contractions. The nurse will interrupt the oxytocin infusion if what occurs?

A) Contractions occur every 2 to 3 minutes.
B) Individual contractions last 2 minutes.
C) Mild to moderate pain occurs with uterine contractions.
D) Resting intrauterine pressure is greater than 10 to 15 mm Hg.

Accepted Answer

Induction of labor in patients of high parity (five or more pregnancies) carries a high risk of uterine rupture, and oxytocin should be used with great caution. Oxytocin infusions should be interrupted for contractions that last longer than 1 minute. Contractions that occur more often than every 2 to 3 minutes are a concern. Mild to moderate pain is normal with contractions. A resting intrauterine pressure greater than 15 to 20 mm Hg is a concern.

Question 9

A patient is in preterm labor, and the prescriber orders magnesium sulfate for its neuroprotective effect on the fetus. The order calls for 4 gm given as an intravenous bolus over 20 minutes, followed by a maintenance infusion of 2 gm/hr. What will the nurse do?

A) Administer the drug as ordered.
B) Question the bolus amount.
C) Question the bolus rate.
D) Question the maintenance amount.

Accepted Answer

For fetal neuroprotective uses, magnesium sulfate should be given using a low-dose protocol, which is a 4-gm IV loading bolus over 20 minutes, followed by a maintenance infusion of 1 gm/hr. A high-dose protocol would have a maintenance infusion of 2 to 3 gm/hr. The nurse should question the maintenance amount. The bolus amount and rate are correct.

Question 10

A patient is admitted to the obstetric unit in preterm labor at 36 weeks' gestation. The prescriber orders a tocolytic agent. When teaching the patient about this medication, the nurse will tell her that tocolytics:

A) are given until term to reduce fetal mortality.
B) are used to help the fetal lungs mature.
C) help delay delivery while glucocorticoids are given.
D) help treat the infections that cause preterm labor.

Accepted Answer

Tocolytic agents are used to postpone premature labor and, on average, for only 48 hours. During this time, glucocorticoids are given to help the fetal lungs mature. Tocolytic agents do not suppress labor long term. They do not directly help the fetal lungs to mature; they help by allowing time for glucocorticoids to be given. They do not treat infection.

Deck 64: Drugs That Affect Uterine Function