OB Pharm

OB Pharm A woman who underwent infertility treatment is pregnant with twins. Which drug might have been responsible? -1 Raloxifene 2 Methylergonovine 3 Clomiphene 4 Dinoprostone Answer: 3 Clomiphene is used as a part of infertility treatment to promote ovulation. However, this drug can lead to multiple pregnancies. Raloxifene is prescribed to prevent postmenopausal osteoporosis. Methylergonovine is prescribed to reduce postpartum uterine hemorrhage. Dinoprostone is prescribed for the termination of a pregnancy. A lactating woman takes fluoxetine to treat depression. Her newborn developed tremors, seizures, and fever. Which drug-induced physiologic alterations may be responsible for the central nervous system effects of the drug on the neonate? -1 Increase in fat content 2 Increase in protein binding 3 Immature blood-brain barrier 4 Delayed first stooling Answer: 3 Many drugs are able to enter the neonate's brain due to the immature blood-brain barrier causing central nervous system effects. Neonates have a low fat content. Protein binding is decreased in neonates because the liver is immature and produces fewer proteins. First pass elimination is decreased in neonates due to the liver's immaturity. A baby was born with a single-lobed brain and also had neural tube defects. Which drug treatment in the client during her gestation might have caused this condition? -1 Simvastatin 2 Isotretinoin 3 Carbamazepine 4 Cyclophosphamide Answer: 1 Neural tube defects and single-lobed brains are teratogenic effects in a newborn associated with simvastatin, an HMG-CoA reductase inhibitor. Isotretinoin may cause central nervous system (CNS) defects. Carbama A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered? -1 Nifedipine 2 Indomethacin 3 Betamethasone 4 Magnesium sulfate Answer: 4 Magnesium sulfate is used to prevent preterm labor in pregnant women with hypertension. To reduce magnesium toxicity caused, calcium gluconate should also be prescribed to counter the effects of this drug. Nifedipine is a calcium channel blocker that inhibits myometrial activity by blocking the calcium influx. Indomethacin is a nonsteroidal antiinflammatory agent used along with sucralfate to protect the stomach. Betamethasone is a corticosteroid used when preterm labor is not maintained by other treatments and delivery is proceeding. A client who received intravenous magnesium sulfate for preeclampsia gives birth. What clinical finding in the newborn indicates to the nurse that magnesium sulfate toxicity may have occurred? -1 Pallor 2 Tremor 3 Hypotonia 4 Tachycardia Answer: 3 Hypotonia occurs with magnesium sulfate toxicity because of skeletal and smooth muscle relaxation. Pallor, tremor, and tachycardia are not signs of magnesium sulfate toxicity. Test-Taking Tip: After you have eliminated one or more choices, you may discover that two of the options are very similar. This can be very helpful because it may mean that one of these look-alike answers is the best choice and the other is a very good distractor. Test both of these options against the stem. Ask yourself which one completes the incomplete statement grammatically and which one answers the question more fully and completely. The option that best completes or answers the stem is the one you should choose. Here, too, pause for a few seconds, give your brain time to reflect, and recall may occur. A lactating woman receives treatment for a medical condition and is taking a prescription medication that cannot be withheld. What type of drugs can the client take to minimize the risk to the neonate? Select all that apply. -1 Drugs that have sustained release 2 Drugs that are excluded from milk 3 Drugs consumed immediately after breastfeeding 4 Drugs that are the least likely to affect the neonate 5 Drugs with the lowest effective dose for longer period Answer: 2, 3, 4 Drugs that do not enter the breast milk are preferred because they are safe for neonates. Drugs should be taken immediately after breastfeeding so that the concentrations of the drug will be low or nonexistent in the next feeding. Drugs that are least likely to affect the infant are preferred. Breast-feeding should be avoided if sustained drugs are taken because they remain for a longer time in plasma. Drugs with the lowest effective doses for a shorter period of time should be taken because they remain in the blood for a shorter period of time. A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply. -1 Monitor vital signs. 2 Encourage the client to track her medications in a journal. 3 Recommend the self-administration of oral drugs. 4 Recommend the long-term use of indomethacin orally. 5 Administer oral drugs to the client when the client wakes up along with six glasses of water. Correct: 1, 2, 3 The nurse should monitor the client's vital signs to minimize the risk of hypotension. Journal tracking of medication helps to ensure the regular administration of the drug. Self-administration of oral drugs at home should be encouraged, and proper instructions regarding the administration should be provided to ensure rational use of the drug. The nurse should not advise the long-term oral use of indomethacin because it may cause birth defects. The administration of oral drugs upon rising with six glasses of water is the nursing intervention for administration of oral bisphosphonates in the treatment of osteoporosis.