Deck 8: Pharmacotherapy During Pregnancy and Lactation

Question 1

The nurse is teaching a prenatal class for mothers with a past history of drug abuse.Which fact about the use of drugs with a breast-feeding infant would the nurse need to emphasize?

A)The infant might experience withdrawal symptoms and test positive for the drug for several hours following exposure.
B)The infant will not experience withdrawal symptoms and will not test positive for the drug following exposure.
C)The infant might experience withdrawal symptoms and test positive for the drug for several days following exposure.
D)The infant might experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure.

Answer 1

The infant might experience withdrawal symptoms and test positive for the drug for several weeks to months following exposure.

Question 2

The nurse educator is explaining the factors that impact the transfer of medications across the placenta.Which factor would be responsible for higher concentrations of a drug being transferred to the fetus through the placenta?

A)Low degree of metabolic activity of the placenta
B)Increased blood flow to the placenta
C)Plasma drug level in the mother
D)Increased blood volume of the mother

Answer 2

Plasma drug level in the mother

Question 3

A client admitted to the emergency department for vaginal bleeding is surprised to find she is in the third trimester of pregnancy.An ultrasound determines the fetus is not viable.The nurse recognizes that which drug could be responsible for the fetal demise?
Select all that apply.

A)Selective serotonin reuptake inhibitors (SSRIs)
B)Fluoroquinolone
C)Acetaminophen
D)Nonsteroidal anti-inflammatory drugs (NSAIDs)
E)Angio-converting enzyme inhibitor (ACE inhibitor)

Answer 3

Nonsteroidal anti-inflammatory drugs (NSAIDs)
Angio-converting enzyme inhibitor (ACE inhibitor)

Question 4

When possible,drug therapy is postponed until after pregnancy and lactation.Which acute and chronic conditions must be managed during pregnancy?
Select all that apply.

A)Epilepsy.
B)Serious cystic acne.
C)Sexually transmitted diseases.
D)Gestational diabetes.
E)Hypertension.

Question 5

The nurse recognizes that which physiological change during pregnancy can alter absorption of medication?

A)Decreased levels of progesterone cause a decrease in gastric tone and intestinal motility.
B)High estrogen levels cause decreased hydrochloric acid production,which may affect the absorption of certain acid labile drugs.
C)An enlarging uterus presses against the stomach,resulting in increased gastric emptying.
D)Increased levels of progesterone increase pulmonary blood flow,resulting in higher serum levels for respiratory drugs.

Question 6

The nurse knows that pregnancy affects the absorption,distribution,metabolism,and excretion of drugs.Which one is the least affected by pregnancy?

A)Distribution
B)Metabolism
C)Excretion
D)Absorption

Question 7

Student nurses are learning about the Food and Drug Administration (FDA)pregnancy categories.What is the best information for the nurse educator to include in the lecture?
Select all that apply.

A)FDA pregnancy categories for individual drugs seldom change once they are established.
B)FDA pregnancy categories are based on clinical human studies.
C)FDA pregnancy categories provide a framework for safe use of drugs in pregnant women.
D)FDA pregnancy category X has been associated with teratogenic effects.
E)FDA pregnancy category C is safe to use during pregnancy.

Question 8

The nurse is teaching a prenatal class for mothers with a past history of drug abuse.Which factor would the nurse need to emphasize about the first trimester of pregnancy?

A)There is very little chance of the fetus being affected by teratogens during this phase.
B)Teratogenic agents taken during this phase can lead to structural malformation and spontaneous abortion.
C)This is the preconceptional period of the pregnancy.
D)Teratogenic agents during this phase do not cause severe malformations in the fetus.

Question 9

The nurse is planning care for a pregnant client prone to substance abuse.When the client states,My baby isn't getting my drugs; I am," which response by the nurse is the most appropriate?
Select all that apply.

A)Most illicit drugs will cross the placenta and hurt the baby."
B)Even drugs that do not cross the placenta can hurt your baby by preventing nutrients from getting across the placenta."
C)Research shows taking drugs can cause your baby to be born too early."
D)You are correct.You are far enough along in your pregnancy that drugs will not harm your baby."
E)If you continue to take drugs,it will make you have a very irritable infant."

Question 10

A pregnant client tells the nurse that her prescribed medication is not as effective as it was before her pregnancy.Which response by the nurse is the most appropriate?

A)"This is because your blood volume has increased."
B)"This is because high estrogen levels increase stomach acid,which may decrease absorption."
C)"Maybe the medication has expired; check the label."
D)"Tell me how you have been taking your medication."

Question 11

The pregnant client plans to breast-feed her baby.She asks the nurse about the use of herbal products during breast-feeding.Which response by the nurse is the most appropriate?

A)"That should be fine as long as at least 12 hours pass between the time you use the product and when you breast-feed."
B)"Most drugs can be transferred to the infant during breast-feeding,so this is not recommended."
C)"Herbal products are considered natural,so it should be fine to use them during breast-feeding."
D)"Be sure to check the label to see whether the herbal product can be used during breast-feeding."

Question 12

The nurse teaching a parenting class would stress what information about adverse drug reactions?
Select all that apply.

A)Common drug effects seen in breast-feeding infants include diarrhea and irritability.
B)The concentration of drugs in breast milk is very high.
C)Effects on the infant can be very serious.
D)There is rarely any effect on the infant.
E)The concentration of drugs in breast milk is very low but may still result in adverse drug effects in an infant.

Question 13

The nurse is preparing a teaching plan for an adolescent postpartum mother.Which topic will the nurse include in the teaching plan?
Select all that apply.

A)Most medications are secreted into breast milk.
B)The new mother's insulin will not be secreted into her breast milk.
C)Over-the-counter (OTC)drugs and herbal products are secreted into breast milk and have the potential to cause harm to the infant.
D)Topical medications must be avoided as these also are secreted into breast milk.
E)Most drugs are safe to take right after breast-feeding because they have not reached the blood stream yet.

Question 14

What should the nurse educator teach as a common reason for difficulty in assessing for side effects of medications during pregnancy?

A)The mother is so uncomfortable with the pregnancy that she chooses to ignore the adverse effects.
B)Adverse effects of medications are not experienced as often with pregnant women.
C)Adverse effects of medications are often similar to common discomforts of pregnancy.
D)The mother has increased blood volume,so the drugs are not strong enough to produce side effects.

Question 15

The nurse tells the expectant mothers during their last prenatal class that their fetus might receive a larger dose of a drug in the later period of their pregnancy.Which processes in the mother's body systems are responsible for this action?

A)Blood flow to placenta increases,and placental vascular membranes become thicker.
B)Blood flow to placenta decreases,and placental vascular membranes become thicker.
C)Blood flow to placenta increases,and placental vascular membranes become thinner.
D)Blood flow to placenta decreases,and placental vascular membranes become thinner.

Question 16

For which client would the nurse expect the health care provider to continue prescribed medications during pregnancy?
Select all that apply.

A)The client recently diagnosed with gonorrhea
B)The client with a history of frequent asthma attacks
C)The client with hypertension
D)The client with frequent insomnia
E)The client with a family history of stroke

Question 17

During a class about the use of medications during pregnancy,the nurse determines that additional information is required when a client makes which statement?

A)"Exposure to some medications can result in my baby's death or in malformations."
B)"The baby can only be harmed by medication during the first trimester."
C)"If I breast-feed my baby,drugs can come through my breast milk."
D)"It is important not to take over-the-counter (OTC)drugs during my pregnancy."

Question 18

A pregnant client suspected of drug abuse is admitted to the emergency department.The nurse plans to teach the client about which complications associated with drug use during pregnancy?
Select all that apply.

A)Preterm birth
B)Low birth weight
C)Birth defects
D)Allergies to narcotics
E)Increased labor

Question 19

The clinic nurse will immediately alert the health care provider when which category X drugs are identified on a recently diagnosed pregnant client?
Select all that apply.

A)Tetracycline
B)ACE inhibitor antihypertensive medication
C)Methotrexate
D)Isotretinoin (Accutane)
E)Oral contraceptives