Question 1

A pregnant patient is 1 week post-term and will receive intravenous oxytocin. Which will the nurse evaluate before starting the infusion?

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 2

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?

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 3

A nurse is caring for a woman during the perinatal and postnatal period. To stop postpartum hemorrhage, how will the nurse administer oxytocin [Pitocin] to this patient?

Accepted Answer

To stop postpartum hemorrhage, oxytocin is administered either IV or IM following delivery of the placenta. If given IV, the dose is 10 to 40 units in 1000 mL of IV fluid. The IM dose is 10 units given as a single injection, also after delivery of the placenta. Misoprostol [Cytotec] is given rectally.

Question 4

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:

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 5

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?

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 6

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?

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 7

A postpartum patient is receiving methylergonovine 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?

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 8

Which drugs are useful for preventing preterm labor?

Accepted Answer

Two drug interventions may help to prevent preterm labor: antibiotics and hydroxyprogesterone. Indomethacin, magnesium sulfate, and terbutaline are all used to stop preterm labor after it starts.

Question 9

Which are indications for early induction of labor?

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 10

A patient who has experienced preterm births with her previous two pregnancies will begin receiving hydroxyprogesterone caproate [Makena] to prevent preterm delivery with her current pregnancy. Which statement by the patient indicates a need for further teaching about this drug?

Accepted Answer

Hydroxyprogesterone caproate is given IM and must be given by a healthcare provider and not by the patient. Although serious side effects are rare, thrombosis and thromboembolism may occur, so the patient should report signs of thrombosis immediately. Fluid retention and glucose intolerance may occur. The medication is given weekly from 16 to 21 weeks' gestation up to 37 weeks or delivery of the baby.

Question 11

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:

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.

Question 12

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?

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.

Quiz 64: Drugs That Affect Uterine Function