NCLEX OB Drugs questions with complete solutions

NCLEX OB Drugs questions with complete solutions What is a tocolytic drug? Medications that produce uterine relaxation and suppress uterine activity in an attempt to stop uterine contractions and prevent preterm birth What is a tocolytic used for? Stopping contractions of the uterus and preventing preterm birth Name some tocolytic drugs indomethacin magnesium sulfate nifedipine terbutaline Contraindications for tocolytic drug therapy: Maternal: severe preeclampsia, active vaginal bleeding, intrauterine infection, cardiac disease, and medical or OB condition that contraindicates the continuation of pregnancy Fetal: estimated gestational age >37 weeks, cervical dilation >4 cm, fetal demise, lethal fetal anomaly, chorioamnionitis, acute fetal distress, and chronic intrauterine growth restriction Interventions for patient receiving tocolytic drugs: Position on side (preferably left) - enhances placental perfusion and reduces pressure on the cervix Monitor maternal vital signs, fetal status and labor status frequently Monitor for signs of averse effects to the medication Monitor daily weight and I&O; provide fluid replacement as indicated Offer comfort measures and provide psychosocial support to client and family What is indomethacin? Prostaglandin inhibitor that relaxes uterine smooth muscle Adverse effects of indomethacin: Maternal: nausea and vomiting, dyspepsia, dizziness Fetal: premature closure of ductus arteriosus Newborn: bronchopulmonary dysplasia, respiratory distress syndrome, intracranial pressure, necrotizing enterocolitis, hyperbilirubinemia Nursing interventions for indomethacin: Used when other methods fail ONLY if gestational age is <32 weeks Not used in clients with bleeding potential, peptic ulcer disease, or oligohydramnios Follow agency protocol Prepare to determine amniotic fluid volume and function of ductus arteriosus before therapy and within 48 hours of dc therapy What is magnesium sulfate? Central nervous system depressant that relaxes smooth muscle, including uterus; used to stop preterm labor contractions and in preeclamptic clients to prevent seizures Also used as an anticonvulsant What are the uses of magnesium sulfate? Stop preterm labor and prevent preterm birth Preventing and controlling seizures in preeclamptic or eclamptic clients Adverse effects of magnesium sulfate: Maternal: depressed respirations, depressed DTRs, hypotension, extreme muscle weakness, flushing, decreased urine output, pulmonary edema, serum magnesium levels >9 mg/dL Newborn: hyponatremia and sleepiness Contraindications of magnesium sulfate: Heart block, myocardial damage, kidney failure Nursing interventions for magnesium sulfate: Always use IV pump for administration Follow protocol of agency Monitor maternal vitals every 30-60 min Assess renal function and cardiac function DC infusion and notify provider if adverse effects occur Monitor for respirations <12/min, urine output <100 mL/4 hrs Monitor magnesium levels and report levels outside therapeutic range (4-7.5 mEq/L) Monitor DTR every hour for signs of toxicity Monitor I&O hourly Keep calcium gluconate available IV administration should not be used for 2 hours preceding delivery What is the antidote for magnesium sulfate? Calcium gluconate What is nifedipine? Calcium channel blocker that relaxes smooth muscles, including the uterus, by blocking calcium entry Adverse effects of nifedipine: Maternal: tachycardia, hypotension, dizziness, headache, nervousness, facial flushing, fatigue, nausea Newborn: hypotension Nursing interventions for nifedipine: Follow agency protocol Avoid use or use cautiously with magnesium sulfate because severe hypotension can occur Monitor for adverse effects What is terbutaline? Beta adrenergic agonist that relaxes smooth muscles, including the uterus, inhibiting uterine activity and causing bronchodilation Adverse effects of terbutaline: Maternal: tachycardia, palpitations, pulmonary edema, chest pain, myocardial ischemia, hypotension, tremors, hypokalemia, hyperglycemia Newborn: tachycardia, hypotension, ileus, hypocalcemia, hyperbilirubinemia, hyperinsulinemia with hypoglycemia Nursing interventions for terbutaline: Monitor for adverse effects and notify provider if they occur What are two corticosteroids commonly used with OB pts? betamethasone and dexamethasone Why are corticosteroids used in pregnancy? To increase the production of surfactant to accelerate fetal lung maturity and reduce incidence/severity of respiratory distress syndrome When are corticosteroids used? When a client is in preterm labor between 28-32 weeks gestation whose labor can be inhibited for 48 hours without jeopardizing the mother or the fetus Adverse effects of corticosteroids: May decrease mother's resistance to infection Pulmonary edema secondary to sodium and fluid retention Elevated blood sugars in a diabetic mother Nursing interventions for corticosteroid use: Monitor maternal vital signs and lung sounds (pulmonary edema) Monitor mother for signs of infection Monitor white blood cell count Monitor blood glucose levels Administer by deep IM injection Why are opioid analgesics used in OB patients? To relieve moderate to severe pain associated with labor How are opioid analgesics administered in the laboring patient? IV or IM Antidotes for opioid analgesics: Naloxone (Narcan) What are some of the opioid analgesics used in the OB client? meperidine hydrochloride (Demerol) hydromorphone hydrochloride (Dilaudid) fentanyl sufentanil (Sufenta) butorphanol tartate nalbuphine Adverse effects of Demerol and Dilaudid: dizziness, nausea, vomiting, sedation, decreased blood pressure, flushed face, urinary retention High dose: respiratory depression, skeletal muscle flacidity, cold, clammy skin, cyanosis, and extreme somnolence progressing to seizures, stupor, and coma To decrease nausea with Demerol and Dilaudid: Give with promethazine (Phenergan) Things to keep in mind when giving Demerol or Dilaudid: Use cautiously in those delivering preterm Not given early in labor process because it may slow the progression of labor Not administered in advanced labor (within 60 minutes of expected delivery) Adverse effects of fentanyl and sufentanil Respiratory depression, dizziness, drowsiness, hypotension, urinary retention, and fetal narcosis and distress Adverse effects of butorphanol tartrate and nalbuphine: Confusion, sedation, sweating, nausea, vomiting, hypotension, sinusoidal-like fetal heart rhythm Nursing interventions when using opioid analgesics: Monitor vital signs - especially respirations Monitor fetal heart rate and characteristics of uterine contractions Monitor for hypotension Assess and reassess pain Monitor for bladder distention and urinary retention Have naloxone readily available What are prostaglandins and why are they used in the OB pt? Used to ripen the cervix, making it softer and causing it to dilate and efface, stimulate uterine contractions To ripen the cervix before induction, induce labor, or induce abortion What are some prostaglandins that are used? Prostaglandin E1: misoprostol Prostaglandin E2: dinoprostone How are prostaglandins administered? Vaginally Adverse effects of prostaglandins: GI effects like nausea, diarrhea, vomiting and stomach cramps; fever, chills, flushing, headache, hypotension, tachysystole (greater than or equal to 12 uterine contractions in 20 minutes without an alteration in the FHR pattern), hyperstimulation of uterus, fetal passage of meconium Contraindications of prostaglandin use: Active cardiac, hepatic, pulmonary, or kidney disease; acute PID, clients who are not indicated to deliver vaginally, fetal malpresentation, hx of c-section, hx of difficult labor or traumatic labor, hypersensitivity to prostaglandins, maternal fever/infection, nonreassuring FHR pattern, placenta previa or unexplained vaginal bleeding, regular progressive uterine contraction Interventions for prostaglandin administration: Monitor maternal vitals, FHR pattern, status of pregnancy Monitor for adverse effects Have void before administration and then maintain supine Discontinue when Bishop score is greater than 8 Follow agency protocol What is oxytocin used for? To stimulate the smooth muscle of the uterus and increase the force, frequency, and duration of uterine contractions. It can also promote milk let down. Induces or augments labor Controls postpartum bleeding Promotes milk let down and facilitates breastfeeding Manages an incomplete abortion How is oxytocin administered? IV to induce labor Intranasal to facilitate breastfeeding Adverse effects of oxytocin: Allergies, dysrhythmias, changes in blood pressure, uterine rupture, and water intoxication. If given intranasally, it can cause nasal vasoconstriction. May produce uterine hypertonicity. High doses may cause hypotension. Postpartum hemorrhage can occur and should be monitored Contraindications of oxytocin: A client who cannot deliver vaginally, client with hypertonic uterine contractions, active genital herpes Interventions for oxytocin: Monitor maternal VS Q15min, especially BP and HR, weight, I&O, LOC, lung sounds Monitor frequency, duration, and force of contractions, and resting uterine tone Q15min Monitor FHR Q15min and notify doctor of significant changes Use IV pump when giving Monitor dose carefully. Do not leave client unattended while giving this Stope if hyperstimulation or nonreassuring FHR Monitor for water intoxication Document everything! What medications can be used to manage postpartum hemorrhage? Ergot alkaloids Prostaglandin F20 Whate are ergot alkaloids? Ergonovine maleate and methylergonovine maleate Directly stimulate uterine muscle, increase the force and frequency of contractions, and produce a firm tetanic contraction of the uterus Can produce arterial vasoconstriction and vasospasm of coronary arteries Administered postpartum and are not administered before the delivery of the placenta Adverse effects of ergot alkaloids: Nausea, uterine cramping, bradycardia, dysrhythmias, MI, and severe hypertension. High doses associated with peripheral vasospasm or vasoconstriction, angina, miosis, confusion, respiratory depression, seizures, or unconsciousness, uterine tetany Contraindications of ergot alkaloids: During pregnancy and in clients with significant cardiovascular disease, peripheral vascular disease, or hypertension Interventions for ergot alkaloids Monitor maternal vitals, weight, I&O, LOC and lung sounds Monitor BP Monitor uterine contractions Assess for chest pain, headache, SOB, itching, pale or cold hands or feet, nausea, diarrhea, dizziness Assess extremities for color, warmth, movement, and pain Assess vaginal bleeding Analgesics as prescribed What is prostaglandin F? Carboprost tromethamine, Hemabate Contracts the uterus Adverse effects of prostaglandin F: Headache, nausea, vomiting, diarrhea, fever, tachycardia, hypertension Contraindications for prostaglandin F: Asthma in the pt Interventions for prostaglandin F: Monitor vitals, vaginal bleeding, and uterine tone What is the Rh (D) immunoglobin (RhoGAM)? Prevention of anti-Rh(D) antibody formation most successful if administered twice at 28 weeks gestation, and again within 72 hours after delivery Should be administered within 72 hours of potential or actual exposure to Rh positive blood Used to prevent isoimmunization in Rh - clients who are negative for Rh antibodies and exposed or potentially exposed to Rh + RBC by amniocentesis, chorionic villus sampling, transfusion, termination of pregnancy, abdominal trauma, or bleeding during pregnancy or birth Adverse effects of RhoGAM: Elevated temperature, tenderness at injection site Contraindications for RhoGAM: Rh+ client, history of systemic allergic reaction to preparations containing human immunoglobins, newborn Interventions for RhoGAM Administer by IM injection at 28 weeks gestation and again within 72 hours of delivery Never administer IV Monitor for elevated temperature Monitor injection site for tenderness What is the rubella vaccination? Given sub-q before d/c from hospital to a nonimmune postpartum client Administered if rubella titer is less than 1:8 Adverse effects of rubella vaccine: Transient rash, hypersensitivity Contraindications for rubella vaccine: Hypersensitivity to eggs Interventions for rubella vaccine: Assess for allergy to duck eggs and notify provider if an allergy exists Do not administer if the client or other family members are immunocompromised Why are lung surfactants used? To replenish surfactant and restore surface activity to the lungs to prevent and treat respiratory distress syndrome in the premature newborn How are lung surfactants administered? Intratracheal rout Adverse effects of lung surfactants: transient bradycardia and oxygen desaturation, pulmonary hemorrhage, mucus plugging, and endotracheal tube reflux Interventions when administering lung surfactants: Instill through catheter inserted in ET tube, avoid suction for two hours after administration Monitor for bradycardia and decreased oxygen saturation during administration Monitor respiratory status and lung sounds and for signs of adverse effects Why is eye prophylaxis used for the newborn? Preventive treatment against ophthalmia neonatorum in the NB is required by law Usually ophthalmic forms of erythromycin are prescribed because they are bacteriostatic and bacteriocidal Prophylactic measure to protect against N. gonorrhoeae and C. trachomatis Adverse effects: Silver nitrate can cause chemical conjunctivitis Interventions for eye prophylaxis: Clean eyes of NB before instilling meds Do not flush the eyes Why is phytonadione (Vitamin K) used? The NB is at risk for hemorrhagic disorders; vitamin K is not synthesized until intestinal bacteria is present. The NB is is deficient in vitamin K for the first 5-8 days postpartum Used to prophylactically treat hemorrhagic disease of the NB Adverse effects of vitamin K: Hyperbilirubinemia Interventions for vitamin K administration: Protect the medication from light Administer during the early NB period Administer IM in the lateral aspect of the middle third of the vastus lateralis muscle of the thigh Monitor for bruising of the injection site Monitor for jaundice and monitor the bilirubin level Hepatitis B vaccine Given IM to the NB before d/c home. This is recommended for all NB Adverse effects of HBV: Rash, fever, erythema, and pain at injection site Interventions for the HBV: Parental consent is needed Administer IM in the lateral aspect of the middle third of the vastus lateralis muscle If a NB is born to a mother positive for Hep B surface antigen, hepatitis B immune globulin should be given within 12 hours of birth in addition to HBV vaccine