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Chapter 40: Drugs Used in Obstetrics

Test Bank

MULTIPLE CHOICE

1. Whichdrug will the health care provider prescribe to soften the cervix of a woman who is at
42 weeks of gestation?

a. Methylergonovine (Methergine)

b. Dinoprostone (Prepidil)
c. Betamethasone (Celestone)

d. Terbutaline (Brethine)

ANS: B

Dinoprostone is a natural chemical in the body that causes uterine and gastrointestinal smooth
muscle stimulation. It plays a role in cervical softening and dilation unrelated to uterine muscle
stimulation. It is used to start and continue cervical ripening at term. Methergine is used to treat
postpartum bleeding. Betamethasone is used to enhance fetal lung development. Terbutaline is
used to treat premature labor.

DIF: Cognitive Level: Comprehension REF: p. 631 OBJ: 4

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

2. For which reason will betamethasone IM be administered to the mother in premature labor?

a. To stop uterine contractions

b. To prevent precipitous labor

c. To stimulate lung maturity in the fetus

d. To stimulate prolactin to enhance breastfeeding

ANS: C

Glucocorticoids may be administered IM to accelerate fetal lung maturation to minimize

respiratory distress syndrome. Tocolytic drugs are given to stop uterine contractions. Prolactin
production and release are triggered by pituitary hormone, estrogen, and progesterone.

DIF: Cognitive Level: Application REF: p. 626 OBJ: 4 | 6

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3. A26-year-old patient with preeclampsia is receiving IV magnesium sulfate. The 1400

assessment includes blood pressure, 100/70 mm Hg; respiration, 10; fetal heart tone, 100/min;
urine output, 20 mL/hr; and absent patellar reflex. Which is the priority nursing action?

Decrease IV magnesium sulfate to half the dose and reassess the patient and fetus in 15
a. minutes.

b. Stop the IV magnesium sulfate and contact the health care provider.

c. Place the patient on her left side and administer oxygen.

d. Stop the IV magnesium sulfate and administer calcium gluconate 5 mEq IV over 3 minutes.

ANS: D

The patient is exhibiting signs of magnesium sulfate toxicity, including respiratory depression.
The infusion should be stopped at once. The antidote, calcium gluconate, should be
administered.

DIF: Cognitive Level: Application REF: pp. 635-636 OBJ: 4 | 6

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Physiological Integrity

4. Which drug is administered after delivery to reduce the risk of postpartum hemorrhage after
the placenta has been delivered?

a. Oxytocin (Pitocin)
b. Magnesium sulfate

c. Vitamin K
d. Dopamine

ANS: A

Uterine stimulants, primarily oxytocin, given in low dose infusions after delivery of the fetus and
placenta, help stimulate firm uterine contractions to reduce the risk of postpartum hemorrhage
from an atonic uterus. Magnesium sulfate is given to treat eclampsia and preeclampsia. Vitamin
K is given to prevent hemorrhage. Dopamine is given to treat hypotension.

DIF: Cognitive Level: Comprehension REF: p. 633 OBJ: 5

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5. A 36-week primigravida patient has been admitted to the unit with a blood pressure of 200/120
mm Hg, severe headache, and edema. Which medication does the nurse anticipate that the health
care provider will order?

a. Nifedipine (Procardia)
b. Furosemide (Lasix)

c. Magnesium sulfate
d. Terbutaline (Brethine)

ANS: C

Magnesium sulfate depresses the central nervous system and blocks peripheral nerve
transmission, which produces anticonvulsant effects and smooth muscle relaxation. In cases of
preeclampsia or eclampsia, magnesium sulfate is used to control seizure activity. Hypertension,
headache, and edema are signs of preeclampsia in a pregnant woman. Calcium channel blockers,
such as nifedipine, are sometimes given as tocolytic agents. Furosemide is given for diuresis; it
may be used in the treatment of hypertension, but not eclampsia. Terbutaline is given as a
tocolytic agent.

DIF: Cognitive Level: Application REF: pp. 635-636 OBJ: 4

TOP: Nursing Process Step: Evaluation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

6. Which drug is administered when a patient is experiencing premature labor?

a. Magnesium sulfate
b. Oxytocin (Pitocin)

c. Levonorgestrel (Mirena)
d. Terbutaline (Brethine)

ANS: D

Terbutaline is a beta adrenergic receptor stimulant, which acts primarily on the beta2 receptors.
Stimulation of beta1 receptors produces uterine relaxation and relaxation of the bronchial and
vascular smooth muscle. In higher doses, terbutaline will stimulate the beta1 receptors, which
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raises heart rate. Magnesium sulfate is given to treat eclampsia. Oxytocin is given to produce
uterine contractions. Levonorgestrel is a progestin given for contraception.

DIF: Cognitive Level: Comprehension REF: pp. 625-626 OBJ: 4 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

7. A patient is a gravida 1, Rh-negative woman at a 28 weeks’ gestation. The father of her child is
Rh positive. The mother is asking the nurse about the effect on her unborn child of RhoGAM
that has been ordered. What is the nurse’s best reply?

a. “Your child will do well after birth once transfusions are administered.”

b. “If the baby is Rh negative at birth, he or she will need RhoGAM also.”
c. “RhoGAM kills antibodies you make, so your child will be protected.”
“Your baby may be Rh positive and cause you to make antibodies. These won’t affect this
d. baby, but could affect future children if RhoGAM isn’t given.”

ANS: D

An Rh-negative mother and an Rh-positive father have the potential for an Rh-positive baby. At
birth or during any time that the uterus ruptures, fetal blood circulation can mix with maternal
circulation, causing the mother to produce antibodies (active immunity) against Rh-positive
blood. This would cause Rh hemolytic disease in children of future pregnancies. Rho(D) immune
globulin suppresses the stimulation of active immunity by Rh-positive foreign red blood cells
that enter maternal circulation at the time of delivery, at the termination of pregnancy, or during
a transfusion of inadequately typed blood. Transfusions may cause further problems. Immune
globulin is given to the mother. The drug does not kill antibodies; it suppresses production.

DIF: Cognitive Level: Application REF: p. 638 OBJ: 7

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

8. Which drug will the nurse administer to prevent neonatal conjunctivitis in the newborn?

a. Silver nitrate

b. Dexamethasone
c. Erythromycin

d. Vitamin K
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ANS: C

Erythromycin or tetracyclines are the drugs of choice because they prevent neonatal
conjunctivitis from Neisseria gonorrhoeae and chlamydial ophthalmia neonatorum
from Chlamydia trachomatis. Silver nitrate is an outdated treatment for neonatal ocular
infections. Dexamethasone is given for lung development. Vitamin K is given for treatment of
hemorrhage.

DIF: Cognitive Level: Comprehension REF: p. 639 OBJ: 3

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

9. Which emergency drug must be available when caring for a patient receiving magnesium
sulfate?

a. Naloxone
b. Calcium gluconate

c. Dextrose
d. Dopamine

ANS: B

Calcium gluconate is the antidote for magnesium sulfate and should always be available when
magnesium sulfate is administered. Naloxone is an antidote for opioid drugs. Dextrose is given
to treat hypoglycemia. Dopamine is given to treat hypotension.

DIF: Cognitive Level: Knowledge REF: p. 637 OBJ: 4 | 6

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

10. Which test would the nurse anticipate to be done to determine if preterm labor is present in a
patient whose symptoms are questionable?

a. Sonogram
b. Fetal fibronectin test

c. Amniocentesis
d. Doppler study
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ANS: B

A fetal fibronectin test may be ordered to assess the presence of preterm labor in patients whose
presenting symptoms are questionable, so that early intervention (e.g., tocolytic therapy,
corticosteroids, transport to a tertiary center) can be initiated when indicated. Sonograms
determine the presence and viability of a fetus. Amniocentesis determines genetic problems in a
fetus. Doppler determines circulation in the vascular system of the mother or the baby.

DIF: Cognitive Level: Comprehension REF: p. 623 OBJ: 6

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

11. Which is characterized by seizures?

a. Pregnancy induced hypertension

b. Preeclampsia

c. Eclampsia
d. Premature rupture of membranes

ANS: C

Eclampsia (convulsions accompanying preeclampsia) is characterized by seizures. Pregnancy

induced hypertension is characterized by sudden hypertension (an elevation of systolic pressure
30 mm Hg or more than prior readings, systolic blood pressure of 140 mm Hg or more, or
diastolic pressure of 90 mm Hg or more). Preeclampsia is characterized by elevated blood
pressure and proteinuria. Premature rupture of membranes is characterized by leakage of
amniotic fluid from the vagina.

DIF: Cognitive Level: Comprehension REF: p. 623 OBJ: 2

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

12. Which medication is used to treat a patient with atonic uterus?

a. Estradiol
b. Ergonovine

c. Ergotamine
d. Egophony
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ANS: B

Continued intravenous infusions of low dose oxytocin or intramuscular injections of ergonovine

or methylergonovine may be used to stimulate firm uterine contractions to reduce the risk of
postpartum hemorrhage from an atonic uterus. Estradiol is an estrogen and is not used to treat
atonic uterus. Ergotamine is used to treat migraine headaches. Egophony is a change in lung
sounds characteristic of plural effusion.

DIF: Cognitive Level: Comprehension REF: pp. 632-633 OBJ: 4 | 5

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

13. A woman is 32 weeks pregnant and has been examined by the health care provider on June 1.
She is scheduling her next appointment. The most appropriate day for the nurse to schedule the
appointment is:

a. June 9.
b. June 16.

c. June 30.
d. July 7.

ANS: B

The pregnant woman who does not experience complications is usually examined monthly for
the first 6 months, every 2 weeks in the seventh and eighth months, and weekly during the last
month.

DIF: Cognitive Level: Analysis REF: p. 622 OBJ: 1

TOP: Nursing Process Step: Planning, Implementation

MSC: NCLEX Client Needs Category: Health Promotion and Maintenance

14. Thenurse administers hydralazine IV to control the blood pressure of a woman diagnosed

with preeclampsia. If the nurse administered this medication at 0800, the next assessment of
blood pressure should occur at:

a. 0803.
b. 0815.

c. 0830.
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d. 1000.

ANS: A

The vasodilator hydralazine is usually administered to control blood pressure. If IV has been
given, monitor the maternal and fetal heart rates and the mother’s blood pressure every 2 to 3
minutes after the initial dose and every 10 to 15 minutes thereafter.

DIF: Cognitive Level: Analysis REF: p. 626 OBJ: 4

TOP: Nursing Process Step: Assessment, Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

15. When caring for the neonate immediately following delivery, the priority nursing diagnosis
will be:

a. risk for bleeding.

b. altered body temperature.

c. ineffective airway clearance.

d. risk for infection.

ANS: C

Ensuring that the airway remains open is the priority because if the airway does not remain
patent, oxygenation will be impaired. Risk for bleeding, altered body temperature, and risk for
infection are relevant but not priorities at this time.

DIF: Cognitive Level: Analysis REF: p. 627 OBJ: 3

TOP: Nursing Process Step: Diagnosis

MSC: NCLEX Client Needs Category: Safe, Effective Care Environment; Physiological Integrity

MULTIPLE RESPONSE

16. Which assessment(s) will the nurse complete during routine pregnancy visits? (Select all that
apply.)

a. Blood pressure
b. Hemoglobin

c. Weight
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d. Fetal heart sounds

e. Glucose tolerance test (GTT)

ANS: A, C, D

Assessments during routine pregnancy visits include blood pressure, weight, and fetal heart
sounds. Assessments during routine pregnancy visits do not include hemoglobin or GTT.

DIF: Cognitive Level: Comprehension REF: p. 621 OBJ: 1

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity

17. Apatient at 33 weeks’ gestation is admitted to the obstetric unit in active labor with
symptoms associated with pregnancy induced hypertension (PIH). Which action(s) will the nurse
implement? (Select all that apply.)

a. Vital signs hourly

b. Administration of IV pitocin

c. Administration of magnesium sulfate IV

d. Fetal stress test

e. Assessment of deep tendon reflexes

ANS: A, C, D, E

Important nursing assessments and/or interventions include monitoring of vital signs and level of
consciousness continuously, continuous fetal monitoring with stress tests and external or internal
fetal monitoring, and deep tendon reflexes. IV magnesium sulfate is often prescribed for patients
with PIH. Oxytocin increases uterine contractions and is contraindicated in preterm labor.

DIF: Cognitive Level: Application REF: p. 626 OBJ: 2

TOP: Nursing Process Step: Implementation

MSC: NCLEX Client Needs Category: Physiological Integrity

18. What will the nurse include when teaching a postpartum patient about expected adverse
effects of Rho(D) immune globulin? (Select all that apply.)

a. Nausea
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b. Constipation
c. Fever

d. Insomnia
e. Aches

f. Diarrhea
g. Anorexia

ANS: C, E

Fever as well as generalized aches and pains are common adverse effects of treatment with this
drug. Nausea, constipation, insomnia, diarrhea, and anorexia are not adverse effects of Rho(D)
immune globulin.

DIF: Cognitive Level: Comprehension REF: p. 638 OBJ: 7

TOP: Nursing Process Step: Assessment

MSC: NCLEX Client Needs Category: Physiological Integrity