Maternity Drugs Practice Exam Quiz
Pharmacology Basics for Maternity
Which of the following drugs is commonly used to induce labor?
a. Oxytocin
b. Magnesium sulfate
c. Betamethasone
d. Nifedipine
What is the primary use of magnesium sulfate in obstetrics?
a. To control postpartum bleeding
b. To prevent seizures in preeclampsia
c. To accelerate fetal lung maturity
d. To induce labor
Which drug is given to promote fetal lung maturity in preterm labor?
a. Terbutaline
b. Betamethasone
c. Misoprostol
d. Methylergonovine
Which of the following drugs is contraindicated in pregnancy due to teratogenic effects?
a. Warfarin
b. Heparin
c. Insulin
d. Labetalol
What is the recommended first-line antihypertensive medication for preeclampsia?
a. Nifedipine
b. Labetalol
c. Methyldopa
d. Hydralazine
Medications for Labor and Delivery
Which drug is used to stop preterm labor?
a. Oxytocin
b. Terbutaline
c. Misoprostol
d. Carboprost
Misoprostol is primarily used in obstetrics for which purpose?
a. To prevent postpartum hemorrhage
b. To ripen the cervix
c. To treat preeclampsia
d. To delay labor
Carboprost is contraindicated in patients with which condition?
a. Asthma
b. Diabetes
c. Hypertension
d. Epilepsy
Which medication is used to control postpartum hemorrhage?
a. Magnesium sulfate
b. Methylergonovine
c. Terbutaline
d. Rho(D) immune globulin
What is the primary purpose of Rho(D) immune globulin (RhoGAM)?
a. To treat anemia during pregnancy
b. To prevent Rh isoimmunization
c. To promote fetal lung development
d. To manage gestational diabetes
Postpartum and Neonatal Medications
Which medication is often used for pain management after a cesarean delivery?
a. Ibuprofen
b. Fentanyl
c. Acetaminophen
d. Morphine
What is the purpose of administering vitamin K to newborns?
a. To prevent jaundice
b. To prevent bleeding disorders
c. To promote weight gain
d. To boost the immune system
Which medication is applied to a newborn’s eyes to prevent gonococcal ophthalmia?
a. Gentamicin
b. Erythromycin
c. Ciprofloxacin
d. Azithromycin
Which drug is used to prevent postpartum uterine atony?
a. Methylergonovine
b. Magnesium sulfate
c. Indomethacin
d. Nifedipine
For which condition is indomethacin used in preterm labor?
a. To treat gestational hypertension
b. To close a patent ductus arteriosus
c. To delay labor
d. To treat chorioamnionitis
Side Effects and Contraindications
Which adverse effect is most associated with oxytocin?
a. Respiratory depression
b. Tachysystole
c. Hypoglycemia
d. Hypercalcemia
Magnesium sulfate toxicity may cause which symptom?
a. Increased reflexes
b. Respiratory depression
c. Hypertension
d. Uterine contractions
What is a common side effect of terbutaline?
a. Bradycardia
b. Hyperglycemia
c. Seizures
d. Drowsiness
A woman taking methylergonovine should be monitored for which side effect?
a. Hypotension
b. Hypertension
c. Bradycardia
d. Edema
What is the primary adverse effect of betamethasone in the mother?
a. Hyperglycemia
b. Hypotension
c. Diarrhea
d. Tachycardia
Special Scenarios
Which medication is used to treat chorioamnionitis?
a. Ampicillin
b. Magnesium sulfate
c. Methylergonovine
d. Rho(D) immune globulin
What is the role of nifedipine in preterm labor?
a. To lower maternal blood pressure
b. To relax the uterus
c. To increase uterine contractions
d. To promote fetal lung maturity
Which drug is used for pain relief during labor through an epidural?
a. Fentanyl
b. Lidocaine
c. Morphine
d. Ropivacaine
Which medication is given to women with a history of preterm birth to prevent recurrence?
a. Progesterone
b. Oxytocin
c. Indomethacin
d. Methylergonovine
Which antibiotic is used to treat group B streptococcus (GBS) during labor?
a. Azithromycin
b. Penicillin G
c. Ceftriaxone
d. Doxycycline
Critical Thinking Questions
A woman at 32 weeks gestation is receiving magnesium sulfate for preeclampsia. What is the nurse’s priority assessment?
a. Blood pressure
b. Respiratory rate
c. Deep tendon reflexes
d. Fetal heart rate
Which medication is used to reverse the effects of opioid-induced respiratory depression in a neonate?
a. Naloxone
b. Epinephrine
c. Flumazenil
d. Rho(D) immune globulin
Why is folic acid supplementation recommended during pregnancy?
a. To prevent preterm labor
b. To prevent neural tube defects
c. To improve fetal lung maturity
d. To control gestational hypertension
A patient receiving betamethasone asks why it is necessary. What is the nurse’s best response?
a. “It reduces your risk of infection during labor.”
b. “It accelerates your baby’s lung development.”
c. “It lowers your blood pressure during labor.”
d. “It prevents preterm contractions.”
What is the therapeutic range for magnesium sulfate in preeclampsia management?
a. 1-3 mg/dL
b. 4-7 mg/dL
c. 8-10 mg/dL
d. 11-15 mg/dL
Medications for Labor Induction and Augmentation
Which medication is used as a cervical ripening agent prior to labor induction?
a. Misoprostol
b. Oxytocin
c. Methylergonovine
d. Nifedipine
What is the mechanism of action of oxytocin during labor?
a. Suppresses uterine contractions
b. Stimulates uterine smooth muscle contraction
c. Relaxes the uterine muscles
d. Blocks prostaglandin synthesis
Dinoprostone is primarily used for which purpose?
a. To control postpartum hemorrhage
b. To ripen the cervix before labor
c. To stop preterm labor
d. To treat preeclampsia
What is the most common side effect of oxytocin infusion during labor?
a. Uterine hyperstimulation (tachysystole)
b. Hypotension
c. Hyperglycemia
d. Fetal bradycardia
Which drug is given to manage uterine atony when oxytocin is not effective?
a. Methylergonovine
b. Terbutaline
c. Magnesium sulfate
d. Misoprostol
Medications for Preterm Labor and Prevention
What is the purpose of tocolytic drugs such as nifedipine?
a. To induce labor
b. To accelerate fetal lung maturity
c. To delay preterm labor
d. To reduce hypertension
Which medication is used as a tocolytic but is contraindicated in mothers with cardiac issues?
a. Terbutaline
b. Indomethacin
c. Oxytocin
d. Nifedipine
What is the maximum recommended duration for administering indomethacin for preterm labor?
a. 24 hours
b. 48 hours
c. 72 hours
d. 7 days
Progesterone injections during pregnancy are primarily used for which condition?
a. Prevention of miscarriage
b. Treatment of preeclampsia
c. Management of preterm labor
d. Prevention of recurrent preterm birth
What is the primary purpose of administering corticosteroids like dexamethasone to pregnant women in preterm labor?
a. To treat maternal infections
b. To lower blood pressure
c. To enhance fetal lung maturity
d. To relax the uterus
Postpartum Hemorrhage Management
Which medication is the first-line treatment for postpartum hemorrhage?
a. Carboprost
b. Oxytocin
c. Methylergonovine
d. Misoprostol
Carboprost is contraindicated in patients with which preexisting condition?
a. Seizures
b. Asthma
c. Renal failure
d. Diabetes
What is a common adverse effect of methylergonovine?
a. Uterine rupture
b. Severe hypertension
c. Bradycardia
d. Hypoglycemia
Misoprostol can be administered via which route to control postpartum hemorrhage?
a. Oral, rectal, or sublingual
b. Intravenous only
c. Subcutaneous only
d. Intramuscular only
What is the primary contraindication for administering methylergonovine postpartum?
a. Hypertension
b. Gestational diabetes
c. Preterm labor
d. Uterine atony
Neonatal Medications
What is the main use of surfactant therapy in neonates?
a. To prevent infections
b. To treat jaundice
c. To improve lung function in premature infants
d. To boost immunity
Which medication is used for prophylaxis against neonatal sepsis caused by GBS?
a. Erythromycin
b. Penicillin G
c. Ampicillin
d. Vancomycin
What is the purpose of administering erythromycin ointment to neonates?
a. To treat sepsis
b. To prevent eye infections
c. To prevent jaundice
d. To enhance immunity
What is the primary indication for giving intravenous immunoglobulin (IVIG) to a newborn?
a. To treat jaundice
b. To boost red blood cell production
c. To prevent hemolytic disease of the newborn
d. To enhance clotting factors
Vitamin K injection is administered to newborns to prevent which condition?
a. Anemia
b. Bleeding disorders
c. Hypoglycemia
d. Jaundice
Other Key Scenarios
Which medication is recommended for the management of eclampsia?
a. Magnesium sulfate
b. Labetalol
c. Nifedipine
d. Oxytocin
What should a nurse monitor when administering magnesium sulfate to a pregnant woman?
a. Platelet count
b. Reflexes and respiratory rate
c. White blood cell count
d. Maternal glucose levels
Which medication is used to reverse the effects of magnesium sulfate toxicity?
a. Calcium gluconate
b. Vitamin D
c. Sodium bicarbonate
d. Potassium chloride
Nifedipine is primarily used in obstetrics for which condition?
a. Hypertensive emergencies
b. Preterm labor management
c. Postpartum hemorrhage
d. Eclampsia treatment
A nurse is preparing to administer Rho(D) immune globulin (RhoGAM). When should it be administered?
a. Within 72 hours postpartum if the mother is Rh-negative and the baby is Rh-positive
b. At 24 weeks gestation for all pregnancies
c. To prevent jaundice in newborns
d. To prevent preterm labor in Rh-positive mothers
Medications for Hypertension and Preeclampsia
Which antihypertensive drug is preferred for severe preeclampsia in pregnancy?
a. Methyldopa
b. Labetalol
c. Atenolol
d. Enalapril
Which medication is used to prevent seizures in women with preeclampsia?
a. Magnesium sulfate
b. Nifedipine
c. Hydralazine
d. Diazepam
Methyldopa is most commonly used in pregnancy for which purpose?
a. To prevent preterm labor
b. To control chronic hypertension
c. To reduce seizure risk
d. To manage postpartum hemorrhage
What is the primary concern with prolonged use of magnesium sulfate?
a. Hyperkalemia
b. Respiratory depression
c. Severe bradycardia
d. Anemia
Which drug is contraindicated for treating hypertension in pregnancy?
a. Methyldopa
b. Lisinopril
c. Nifedipine
d. Hydralazine
Antibiotics and Infection Prevention
Which antibiotic is used to treat urinary tract infections (UTIs) during pregnancy?
a. Ciprofloxacin
b. Amoxicillin
c. Doxycycline
d. Tetracycline
Which antibiotic is given to a pregnant woman with positive Group B Streptococcus (GBS) colonization?
a. Azithromycin
b. Ceftriaxone
c. Penicillin G
d. Clindamycin
What is the antibiotic of choice for chorioamnionitis in pregnancy?
a. Ampicillin and gentamicin
b. Vancomycin
c. Ciprofloxacin
d. Trimethoprim-sulfamethoxazole
Which antibiotic should be avoided in pregnancy due to the risk of fetal harm?
a. Amoxicillin
b. Erythromycin
c. Tetracycline
d. Cephalexin
Which medication is used to treat bacterial vaginosis in pregnant women?
a. Metronidazole
b. Ciprofloxacin
c. Doxycycline
d. Gentamicin
Medications for Fetal Protection
Which medication is administered to Rh-negative mothers to prevent hemolytic disease of the newborn?
a. Vitamin K
b. Rho(D) immune globulin (RhoGAM)
c. Calcium gluconate
d. Surfactant
What is the purpose of administering betamethasone in preterm labor?
a. To treat hypertension
b. To reduce fetal distress
c. To promote fetal lung maturity
d. To stop uterine contractions
A mother in labor receives indomethacin. What is its primary purpose in preterm labor?
a. To ripen the cervix
b. To delay labor by inhibiting prostaglandins
c. To promote uterine contractions
d. To manage maternal hypertension
What is the recommended timing for administering Rho(D) immune globulin (RhoGAM) during pregnancy?
a. At 28 weeks and postpartum
b. At 32 weeks only
c. During active labor
d. At 24 weeks and postpartum
Which drug is used for fetal neuroprotection during preterm labor?
a. Magnesium sulfate
b. Oxytocin
c. Labetalol
d. Nifedipine
Pain Management in Labor and Delivery
Which opioid is commonly used for pain relief during labor?
a. Morphine
b. Fentanyl
c. Oxycodone
d. Hydrocodone
What is a potential side effect of epidural anesthesia during labor?
a. Hyperglycemia
b. Hypotension
c. Increased platelet count
d. Fetal tachycardia
Which non-opioid medication is safe for pain relief during pregnancy?
a. Ibuprofen
b. Acetaminophen
c. Aspirin
d. Naproxen
Naloxone is used in maternity care to reverse the effects of which medication?
a. Fentanyl
b. Oxytocin
c. Methyldopa
d. Betamethasone
A patient receiving an epidural asks about potential complications. Which is a common risk?
a. Respiratory depression
b. Prolonged labor
c. Hypotension and fetal distress
d. Uterine rupture
Postpartum and Lactation Medications
Which drug is most commonly used to promote lactation?
a. Oxytocin
b. Metoclopramide
c. Domperidone
d. Propranolol
What is the first-line treatment for mastitis in breastfeeding mothers?
a. Amoxicillin
b. Dicloxacillin
c. Ciprofloxacin
d. Doxycycline
Which pain relief medication is safe for use while breastfeeding?
a. Aspirin
b. Ibuprofen
c. Codeine
d. Celecoxib
Cabergoline is used postpartum for which purpose?
a. To enhance milk production
b. To suppress lactation
c. To treat postpartum hemorrhage
d. To manage postpartum depression
Which medication is used for severe postpartum depression?
a. Fluoxetine
b. Haloperidol
c. Methylergonovine
d. Sertraline
Management of Preterm Labor
Which medication is used as a tocolytic to delay preterm labor?
a. Oxytocin
b. Indomethacin
c. Dinoprostone
d. Ergonovine
Terbutaline is primarily used during pregnancy for which purpose?
a. Inducing labor
b. Relaxing uterine muscles to prevent contractions
c. Treating preeclampsia
d. Enhancing fetal lung maturity
What is the primary side effect of nifedipine used in preterm labor management?
a. Tachycardia
b. Hypotension
c. Hyperglycemia
d. Pulmonary edema
Which medication is contraindicated as a tocolytic in women with heart disease?
a. Magnesium sulfate
b. Indomethacin
c. Terbutaline
d. Nifedipine
A pregnant woman at risk for preterm labor receives indomethacin. What complication may occur in the fetus with prolonged use?
a. Pulmonary hypertension
b. Renal dysplasia
c. Closure of the ductus arteriosus
d. Cardiac arrhythmias
Labor Induction and Augmentation
What is the primary purpose of administering oxytocin during labor?
a. To suppress uterine contractions
b. To induce or augment uterine contractions
c. To enhance fetal circulation
d. To relieve pain during labor
Which is a common side effect of oxytocin infusion?
a. Hyperglycemia
b. Uterine tachysystole
c. Fetal bradycardia
d. Increased maternal blood pressure
Dinoprostone is primarily used for which purpose in maternity care?
a. To delay preterm labor
b. To induce cervical ripening
c. To treat postpartum hemorrhage
d. To manage pregnancy-induced hypertension
Misoprostol is contraindicated for labor induction in which case?
a. Post-term pregnancy
b. Previous cesarean delivery
c. Intrauterine growth restriction
d. Suspected preeclampsia
Which drug is used to reduce postpartum bleeding after delivery?
a. Oxytocin
b. Misoprostol
c. Methylergonovine
d. All of the above
Management of Postpartum Hemorrhage (PPH)
What is the drug of choice for managing postpartum hemorrhage due to uterine atony?
a. Tranexamic acid
b. Methylergonovine
c. Oxytocin
d. Carboprost tromethamine
Which medication is contraindicated for PPH in women with asthma?
a. Methylergonovine
b. Misoprostol
c. Carboprost tromethamine
d. Tranexamic acid
Tranexamic acid is used during postpartum hemorrhage to:
a. Promote uterine contractions
b. Prevent fibrinolysis and stabilize clots
c. Replace blood volume
d. Enhance cervical dilation
What is the main side effect of methylergonovine?
a. Diarrhea
b. Hypertension
c. Fever
d. Drowsiness
Carboprost tromethamine is used cautiously in which population?
a. Women with hypertension
b. Women with diabetes
c. Women with asthma
d. Women with thyroid disorders
Analgesics and Anesthesia
Which medication is used as an epidural analgesic during labor?
a. Lidocaine
b. Bupivacaine
c. Morphine
d. Diazepam
Epidural anesthesia may lead to which maternal side effect?
a. Hypertension
b. Hypotension
c. Hyperglycemia
d. Seizures
Which opioid analgesic is commonly administered intravenously for labor pain?
a. Oxycodone
b. Fentanyl
c. Hydromorphone
d. Tramadol
What is the most common side effect of opioid analgesics given during labor?
a. Maternal bradycardia
b. Neonatal respiratory depression
c. Seizures
d. Maternal hypertension
Naloxone can be used to reverse the effects of which drug in a newborn?
a. Oxytocin
b. Fentanyl
c. Lidocaine
d. Methylergonovine
Pregnancy-Specific Medications
What is the primary purpose of folic acid supplementation during pregnancy?
a. To reduce anemia
b. To prevent neural tube defects
c. To manage gestational diabetes
d. To improve fetal lung maturity
Iron supplementation in pregnancy is commonly associated with which side effect?
a. Diarrhea
b. Constipation
c. Hyperkalemia
d. Hypoglycemia
What is the primary medication used to treat gestational diabetes?
a. Metformin
b. Glyburide
c. Insulin
d. All of the above
Which anticoagulant is safe to use during pregnancy?
a. Warfarin
b. Heparin
c. Dabigatran
d. Rivaroxaban
Vitamin K is administered to newborns to prevent which condition?
a. Neonatal sepsis
b. Hemorrhagic disease of the newborn
c. Neonatal jaundice
d. Hypocalcemia
Management of Hypertension in Pregnancy
Which medication is commonly used to manage chronic hypertension in pregnancy?
a. Lisinopril
b. Methyldopa
c. Amlodipine
d. Losartan
Hydralazine is used during pregnancy for which condition?
a. Hyperglycemia
b. Severe hypertension
c. Uterine atony
d. Fetal tachycardia
Which antihypertensive drug class is contraindicated in pregnancy due to teratogenicity?
a. Calcium channel blockers
b. Beta-blockers
c. ACE inhibitors
d. Alpha agonists
Which side effect is most common with labetalol in pregnant women?
a. Bradycardia
b. Hyperkalemia
c. Hyperglycemia
d. Edema
Magnesium sulfate is used in preeclampsia for which purpose?
a. Lowering blood pressure
b. Preventing seizures
c. Enhancing fetal lung maturity
d. Inducing labor
Fetal Lung Maturity
What is the primary purpose of administering corticosteroids in preterm labor?
a. To enhance fetal lung maturity
b. To prevent uterine contractions
c. To reduce maternal hypertension
d. To treat infections
Which corticosteroid is commonly used to promote fetal lung maturity?
a. Dexamethasone
b. Hydrocortisone
c. Betamethasone
d. Prednisolone
Corticosteroid therapy is recommended between which weeks of gestation to improve fetal outcomes?
a. 18–24 weeks
b. 24–34 weeks
c. 35–38 weeks
d. After 40 weeks
What is a potential side effect of corticosteroid use in pregnant women?
a. Hyperglycemia
b. Hypotension
c. Uterine atony
d. Fetal bradycardia
In a pregnant woman with diabetes, corticosteroid administration requires:
a. Increased insulin monitoring and dosage adjustments
b. Switching from insulin to oral medications
c. Discontinuation of diabetes treatment
d. Avoidance of corticosteroids
Antibiotics in Pregnancy
Which antibiotic is safe for treating urinary tract infections (UTIs) in pregnancy?
a. Ciprofloxacin
b. Nitrofurantoin
c. Doxycycline
d. Chloramphenicol
Which antibiotic is commonly used to treat Group B Streptococcus during labor?
a. Vancomycin
b. Penicillin G
c. Azithromycin
d. Levofloxacin
Tetracyclines are contraindicated during pregnancy due to which effect?
a. Teratogenicity
b. Fetal liver toxicity
c. Discoloration of fetal teeth
d. Premature closure of the ductus arteriosus
Which antibiotic is used to treat chorioamnionitis during labor?
a. Ampicillin and gentamicin
b. Ceftriaxone
c. Azithromycin
d. Linezolid
Erythromycin is often used in pregnant women for which indication?
a. Group B Streptococcus prophylaxis
b. Syphilis treatment
c. Treatment of chlamydia infections
d. Fungal infections
Management of Nausea and Vomiting
Which medication is considered first-line therapy for nausea and vomiting during pregnancy?
a. Ondansetron
b. Metoclopramide
c. Doxylamine and pyridoxine
d. Promethazine
What is a common side effect of metoclopramide in pregnant women?
a. Drowsiness
b. Constipation
c. Hypertension
d. Hyperglycemia
Ondansetron is often prescribed in pregnancy for:
a. Preventing seizures
b. Treating hyperemesis gravidarum
c. Managing hypertension
d. Enhancing fetal circulation
Which herbal supplement is sometimes used to manage mild nausea in pregnancy?
a. Ginger
b. Echinacea
c. Ginseng
d. St. John’s Wort
Hyperemesis gravidarum may require the use of which class of medications?
a. Antibiotics
b. Antiemetics
c. Anticoagulants
d. Diuretics
Miscellaneous
Rho(D) immune globulin is administered during pregnancy to:
a. Treat Rh incompatibility
b. Prevent Rh isoimmunization
c. Enhance fetal lung maturity
d. Manage maternal anemia
Which condition warrants the administration of Rho(D) immune globulin postpartum?
a. The newborn is Rh-negative
b. The mother is Rh-negative and the baby is Rh-positive
c. The mother is Rh-positive
d. The mother and baby have the same blood type
Vitamin D supplementation during pregnancy is primarily used to prevent:
a. Neural tube defects
b. Rickets in the fetus
c. Preterm labor
d. Preeclampsia
What is the purpose of administering IV antibiotics during labor in women with preterm rupture of membranes?
a. To prevent neonatal sepsis
b. To reduce maternal fever
c. To delay labor
d. To treat urinary tract infections
Levothyroxine is prescribed in pregnancy to treat:
a. Hypothyroidism
b. Hyperthyroidism
c. Gestational diabetes
d. Preeclampsia
Pain Management in Labor
Which opioid is commonly used for pain relief during labor?
a. Morphine
b. Fentanyl
c. Oxycodone
d. Tramadol
Epidural analgesia involves the administration of which type of medication?
a. Anticholinergic
b. Local anesthetic and opioid
c. NSAID and corticosteroid
d. Anticoagulant and analgesic
Which medication is used to reverse opioid-induced respiratory depression in a newborn?
a. Naloxone
b. Magnesium sulfate
c. Atropine
d. Flumazenil
Nitrous oxide is used during labor for:
a. Enhancing uterine contractions
b. Pain relief
c. Reducing maternal blood pressure
d. Fetal heart rate monitoring
What is a common side effect of using opioids for pain relief during labor?
a. Uterine rupture
b. Fetal bradycardia
c. Maternal sedation
d. Hypertension
Medications for Postpartum Hemorrhage
Which medication is first-line for managing postpartum hemorrhage?
a. Oxytocin
b. Misoprostol
c. Methylergonovine
d. Tranexamic acid
Methylergonovine should be avoided in patients with:
a. Hypotension
b. Hypertension
c. Anemia
d. Hyperglycemia
What is the purpose of administering carboprost in postpartum hemorrhage?
a. To stimulate uterine contractions
b. To reduce maternal fever
c. To prevent coagulopathy
d. To enhance lactation
Misoprostol is administered for postpartum hemorrhage via:
a. Intravenous injection
b. Oral or rectal route
c. Subcutaneous injection
d. Epidural infusion
Tranexamic acid is used in postpartum hemorrhage to:
a. Reduce uterine atony
b. Prevent clot breakdown
c. Stimulate uterine contractions
d. Enhance oxytocin release
Gestational Diabetes
What is the first-line treatment for gestational diabetes?
a. Metformin
b. Lifestyle and dietary modifications
c. Insulin
d. Glyburide
Which form of insulin is typically used in pregnancy?
a. Regular insulin and NPH insulin
b. Lantus (glargine)
c. Lispro and aspart insulin
d. Insulin detemir
What is the primary goal of gestational diabetes treatment?
a. Reduce maternal weight gain
b. Maintain blood glucose control
c. Prevent maternal anemia
d. Enhance fetal growth
Glyburide may be used in pregnancy for gestational diabetes if:
a. Insulin is contraindicated
b. Dietary management fails
c. The patient prefers oral therapy
d. Both b and c
Uncontrolled gestational diabetes increases the risk of:
a. Preterm labor
b. Macrosomia
c. Shoulder dystocia
d. All of the above
Induction of Labor
Which medication is most commonly used to induce labor?
a. Oxytocin
b. Terbutaline
c. Misoprostol
d. Dinoprostone
Misoprostol is contraindicated for labor induction in:
a. Post-term pregnancy
b. Women with a history of uterine rupture
c. Premature rupture of membranes
d. Nulliparous women
Dinoprostone is used during labor for:
a. Cervical ripening
b. Pain relief
c. Preventing fetal distress
d. Enhancing lactation
Oxytocin administration requires close monitoring of:
a. Fetal heart rate and uterine contractions
b. Maternal oxygen levels
c. Maternal blood sugar levels
d. Placental circulation
A potential complication of oxytocin use in labor is:
a. Tachysystole
b. Fetal bradycardia
c. Uterine rupture
d. All of the above
Miscellaneous
Terbutaline is used during pregnancy to:
a. Enhance fetal lung maturity
b. Treat uterine tachysystole
c. Manage hypertension
d. Reduce maternal fever
Which medication is administered for thromboprophylaxis in pregnant women at high risk of clots?
a. Warfarin
b. Low-molecular-weight heparin (LMWH)
c. Aspirin
d. Apixaban
Warfarin is contraindicated in pregnancy due to its:
a. Risk of fetal malformations
b. Short half-life
c. Ineffectiveness in preventing clots
d. Incompatibility with labor medications
Antacids like calcium carbonate are often prescribed in pregnancy to treat:
a. Nausea and vomiting
b. Heartburn and acid reflux
c. Constipation
d. Uterine cramping
Iron supplements in pregnancy are typically given to prevent:
a. Preeclampsia
b. Anemia
c. Hypoglycemia
d. Uterine atony
Questions and Answers for Study Guide
Discuss the use of oxytocin in labor and delivery. Include its indications, mechanism of action, administration, side effects, and nursing considerations.
Answer:
Oxytocin is a synthetic hormone commonly used in labor and delivery to induce or augment labor and manage postpartum hemorrhage.
Indications:
- Induction of labor in cases of prolonged pregnancy or medical conditions such as preeclampsia.
- Augmentation of labor when uterine contractions are inadequate.
- Prevention and treatment of postpartum hemorrhage.
Mechanism of Action:
Oxytocin stimulates uterine smooth muscle contractions by binding to oxytocin receptors on the uterus. This increases intracellular calcium levels, leading to rhythmic contractions that facilitate labor.
Administration:
Oxytocin is administered intravenously (IV) via a controlled infusion pump. Dosages are titrated based on uterine response and fetal monitoring.
Side Effects:
- Uterine tachysystole (excessively frequent contractions).
- Fetal distress due to decreased oxygenation.
- Hypotension or water intoxication in the mother (rare).
Nursing Considerations:
- Continuous monitoring of fetal heart rate (FHR) and uterine contractions is essential.
- Stop oxytocin if fetal distress or uterine hyperstimulation occurs.
- Educate the patient and family about the purpose and potential side effects of the medication.
Explain the role of magnesium sulfate in pregnancy. Include its indications, dosing, monitoring requirements, and potential complications.
Answer:
Magnesium sulfate is an essential medication used during pregnancy to prevent and manage conditions like preeclampsia and eclampsia.
Indications:
- Prevention and treatment of seizures in preeclampsia/eclampsia.
- Neuroprotection for preterm neonates by reducing the risk of cerebral palsy.
- Tocolysis to delay preterm labor (less commonly used).
Dosing:
Magnesium sulfate is administered intravenously, typically as a loading dose of 4–6 grams over 20–30 minutes, followed by a maintenance infusion of 1–2 grams per hour.
Monitoring Requirements:
- Close monitoring of maternal vital signs, reflexes, and urine output is critical to prevent toxicity.
- Serum magnesium levels are measured regularly to ensure therapeutic levels (4–7 mEq/L).
- Continuous fetal heart rate monitoring is required.
Potential Complications:
- Magnesium toxicity, indicated by loss of deep tendon reflexes, respiratory depression, or cardiac arrest.
- Nausea, flushing, and muscle weakness.
- Neonatal respiratory depression if administered close to delivery.
Nursing Considerations:
- Administer calcium gluconate as an antidote for magnesium toxicity.
- Educate the patient about the purpose and potential side effects.
- Monitor fetal status for any adverse effects.
Analyze the risks and benefits of using corticosteroids during pregnancy for fetal lung maturity.
Answer:
Corticosteroids, such as betamethasone and dexamethasone, are critical in promoting fetal lung maturity when there is a risk of preterm birth.
Benefits:
- Accelerates fetal lung surfactant production, reducing the risk of neonatal respiratory distress syndrome (RDS).
- Lowers the risk of intraventricular hemorrhage and necrotizing enterocolitis in preterm infants.
- Proven to improve neonatal survival rates.
Risks:
- Transient maternal hyperglycemia, which can exacerbate gestational diabetes.
- Potential risk of neonatal hypoglycemia after birth due to increased insulin production.
- Rarely, maternal infection or chorioamnionitis may worsen.
Administration and Timing:
Corticosteroids are typically administered intramuscularly (IM) between 24 and 34 weeks of gestation in women at risk of preterm delivery within 7 days. The regimen involves two doses of betamethasone 24 hours apart or four doses of dexamethasone 12 hours apart.
Nursing Considerations:
- Monitor maternal blood glucose levels, especially in diabetic patients.
- Educate the patient about the importance of corticosteroids for fetal health.
- Observe for signs of infection and manage accordingly.
Evaluate the use of anticoagulants in pregnancy. Discuss the differences between low-molecular-weight heparin (LMWH) and warfarin.
Answer:
Anticoagulants are vital in managing thromboembolic conditions during pregnancy, such as deep vein thrombosis (DVT) and pulmonary embolism (PE).
Low-Molecular-Weight Heparin (LMWH):
- Safe for use during pregnancy because it does not cross the placenta.
- Common drugs include enoxaparin and dalteparin.
- Administered subcutaneously with weight-adjusted dosing.
- Minimal risk of bleeding compared to unfractionated heparin.
Warfarin:
- Contraindicated in pregnancy due to teratogenic effects, including fetal malformations (warfarin embryopathy).
- Used only postpartum or in high-risk cases where benefits outweigh risks.
Nursing Considerations:
- Educate pregnant patients about the importance of anticoagulation therapy in preventing life-threatening clots.
- Monitor for signs of bleeding or bruising.
- Ensure regular blood tests (e.g., anti-Xa levels for LMWH) to monitor efficacy.
Describe the pharmacological management of postpartum hemorrhage and the rationale for using specific drugs.
Answer:
Postpartum hemorrhage (PPH) is a leading cause of maternal morbidity and mortality, requiring prompt pharmacological intervention.
Drugs Used:
- Oxytocin: First-line drug to stimulate uterine contractions and reduce bleeding. Administered intravenously or intramuscularly.
- Misoprostol: A prostaglandin analog that induces strong uterine contractions. Given orally or rectally, particularly in low-resource settings.
- Methylergonovine: Used when oxytocin is insufficient. Contraindicated in hypertension due to its vasoconstrictive properties.
- Carboprost (Hemabate): A prostaglandin used for refractory PPH. Administered intramuscularly but can cause gastrointestinal side effects like diarrhea.
- Tranexamic Acid: An antifibrinolytic agent that prevents clot breakdown. Used as an adjunct in severe cases of bleeding.
Rationale:
- All these drugs aim to stimulate uterine contraction, reduce uterine atony, and minimize blood loss.
- Antifibrinolytics help stabilize clots, particularly in trauma-related PPH.
Nursing Considerations:
- Monitor maternal vital signs, uterine tone, and bleeding patterns.
- Assess for side effects like hypertension (methylergonovine) or gastrointestinal distress (carboprost).
- Educate the patient about the treatment plan and monitor for potential allergic reactions.
Discuss the role of terbutaline in managing preterm labor. Include its mechanism of action, contraindications, side effects, and nursing considerations.
Answer:
Terbutaline is a beta-adrenergic agonist used as a tocolytic to delay preterm labor temporarily.
Mechanism of Action:
Terbutaline works by stimulating beta-2 adrenergic receptors, which relax the smooth muscles of the uterus and inhibit contractions.
Contraindications:
- Cardiac conditions like arrhythmias or severe hypertension.
- Hyperthyroidism or poorly controlled diabetes mellitus.
- Gestational age >34 weeks or when preterm delivery is medically necessary.
Side Effects:
- Maternal tachycardia, palpitations, and chest pain.
- Tremors, headache, and nervousness.
- Hyperglycemia and hypokalemia.
- Fetal tachycardia or hyperinsulinemia in prolonged use.
Nursing Considerations:
- Monitor maternal heart rate; discontinue if it exceeds 120 beats per minute.
- Educate the patient on common side effects like tremors and palpitations.
- Administer terbutaline cautiously, and ensure it is used for short-term management only.
Examine the use of antibiotics in managing infections during pregnancy. Discuss considerations for drug selection and examples of safe antibiotics.
Answer:
Antibiotics are crucial for treating maternal infections and preventing vertical transmission to the fetus, but drug safety is paramount during pregnancy.
Considerations for Drug Selection:
- Antibiotics must be effective against the specific pathogen while posing minimal risk to the fetus.
- Drugs classified as FDA Pregnancy Category B (e.g., penicillins, cephalosporins) are preferred.
- Avoid teratogenic drugs such as tetracyclines, which can affect fetal bone and teeth development.
Safe Antibiotics:
- Penicillins (e.g., amoxicillin): Safe and effective for infections like urinary tract infections (UTIs) and group B streptococcus (GBS).
- Cephalosporins (e.g., ceftriaxone): Broad-spectrum antibiotics used for UTIs and respiratory infections.
- Macrolides (e.g., azithromycin): Used for atypical bacterial infections and chlamydia.
Nursing Considerations:
- Educate patients on completing the entire antibiotic course to prevent resistance.
- Monitor for allergic reactions, particularly with penicillins and cephalosporins.
- Assess for symptoms of superinfection, such as fungal overgrowth.
Analyze the use of Rho(D) immune globulin (RhoGAM) in pregnancy. Include its purpose, indications, timing of administration, and nursing responsibilities.
Answer:
Rho(D) immune globulin is an immunoglobulin administered to Rh-negative mothers to prevent Rh sensitization.
Purpose:
RhoGAM prevents the maternal immune system from developing antibodies against Rh-positive fetal red blood cells, which could lead to hemolytic disease of the newborn in subsequent pregnancies.
Indications:
- Administered prophylactically at 28 weeks of gestation to Rh-negative mothers.
- Given after any event where fetal-maternal hemorrhage may occur, such as miscarriage, trauma, or invasive procedures.
- Postpartum administration within 72 hours if the newborn is Rh-positive.
Nursing Responsibilities:
- Verify the mother’s Rh-negative status and confirm the absence of existing anti-D antibodies.
- Administer RhoGAM intramuscularly as prescribed.
- Educate the mother on the importance of receiving RhoGAM to protect future pregnancies.
Discuss the pharmacological treatment of hyperemesis gravidarum and the nursing care involved.
Answer:
Hyperemesis gravidarum (HG) is severe nausea and vomiting during pregnancy, requiring medication and supportive care.
Pharmacological Treatment:
- Vitamin B6 (Pyridoxine) and Doxylamine: First-line treatment for mild to moderate nausea and vomiting.
- Ondansetron: Used in more severe cases to block serotonin receptors and reduce nausea.
- Metoclopramide: Promotes gastric emptying and reduces vomiting.
- Corticosteroids: Reserved for refractory cases.
Nursing Care:
- Monitor fluid and electrolyte levels; administer IV fluids to correct dehydration.
- Assess nutritional status and initiate enteral or parenteral nutrition if necessary.
- Provide emotional support, as HG can significantly impact quality of life.
Evaluate the risks and benefits of using antidepressants during pregnancy. Include examples of commonly used drugs and their potential impact.
Answer:
Antidepressants are used during pregnancy to manage maternal mental health while minimizing risks to the fetus.
Benefits:
- Treating depression improves maternal well-being and bonding with the newborn.
- Prevents complications like preterm birth associated with untreated depression.
Risks:
- Selective serotonin reuptake inhibitors (SSRIs) like sertraline may increase the risk of neonatal adaptation syndrome (e.g., jitteriness, irritability).
- Tricyclic antidepressants (TCAs) have been associated with potential fetal malformations in earlier studies, though the risk is minimal.
- Persistent pulmonary hypertension of the newborn (PPHN) is a rare potential complication with SSRI use.
Examples of Safe Antidepressants:
- SSRIs (e.g., sertraline): Generally considered first-line for moderate to severe depression.
- TCAs (e.g., amitriptyline): Used when SSRIs are contraindicated.
Nursing Considerations:
- Educate patients on the importance of adhering to prescribed medications.
- Monitor for side effects in both the mother and newborn.
- Collaborate with mental health professionals to provide holistic care.
Describe the use of antihypertensive medications in pregnancy. Compare labetalol and methyldopa in terms of safety, mechanism of action, and side effects.
Answer:
Hypertension during pregnancy requires careful management to prevent complications such as preeclampsia.
Labetalol:
- Mechanism of Action: A combined alpha- and beta-blocker that reduces blood pressure by decreasing vascular resistance.
- Safety: Safe for use in pregnancy and effective for acute hypertensive crises.
- Side Effects: Bradycardia, dizziness, and fatigue.
Methyldopa:
- Mechanism of Action: A central alpha-2 agonist that decreases sympathetic outflow, reducing blood pressure.
- Safety: Long-standing safety record in pregnancy, particularly for chronic hypertension.
- Side Effects: Sedation, depression, and liver dysfunction (rare).
Comparison:
Labetalol is often preferred for rapid blood pressure control, while methyldopa is used for long-term management.
Nursing Considerations:
- Monitor maternal blood pressure and fetal growth regularly.
- Educate the patient about medication adherence and potential side effects.
Explain the use of magnesium sulfate in pregnancy-related complications, including its indications, monitoring parameters, and potential complications.
Answer:
Magnesium sulfate is a critical medication used in obstetric care to manage preeclampsia, eclampsia, and preterm labor.
Indications:
- Prevents and treats seizures in severe preeclampsia and eclampsia.
- Provides neuroprotection for preterm fetuses <32 weeks gestation.
- Used as a tocolytic to delay preterm labor temporarily.
Monitoring Parameters:
- Monitor serum magnesium levels (therapeutic range: 4–7 mEq/L).
- Assess reflexes regularly; absent deep tendon reflexes indicate toxicity.
- Monitor respiratory rate (should remain ≥12 breaths per minute) and urinary output (≥30 mL/hour).
Potential Complications:
- Magnesium toxicity, presenting as respiratory depression, hypotension, and bradycardia.
- Fetal side effects, such as reduced variability in heart rate monitoring.
Nursing Responsibilities:
- Administer the antidote, calcium gluconate, in case of magnesium toxicity.
- Educate the patient about the purpose and possible side effects of the drug.
Analyze the pharmacological management of postpartum hemorrhage. Include key drugs used and their mechanisms of action.
Answer:
Postpartum hemorrhage (PPH) is a leading cause of maternal mortality, requiring rapid pharmacological intervention.
Key Drugs and Mechanisms of Action:
- Oxytocin: Stimulates uterine contractions to promote hemostasis. Administered intravenously or intramuscularly as the first-line drug.
- Misoprostol: A prostaglandin E1 analog that induces strong uterine contractions and reduces blood loss. Administered orally, sublingually, or rectally.
- Methylergonovine: An ergot alkaloid that causes sustained uterine contractions. Contraindicated in hypertensive patients.
- Carboprost Tromethamine: A prostaglandin F2α analog used for refractory cases; contraindicated in patients with asthma.
Nursing Responsibilities:
- Monitor vital signs, uterine tone, and bleeding during drug administration.
- Educate the patient about possible side effects like nausea, fever, and diarrhea.
Discuss the role of corticosteroids in enhancing fetal lung maturity. Include indications, administration timing, and potential side effects.
Answer:
Corticosteroids like betamethasone and dexamethasone are vital in preterm labor management to improve fetal lung maturity.
Indications:
- Administered to women at risk of preterm delivery between 24 and 34 weeks gestation.
- Reduces the risk of respiratory distress syndrome (RDS), intraventricular hemorrhage, and neonatal mortality.
Administration Timing:
- Two doses of betamethasone (12 mg intramuscularly) are given 24 hours apart.
- Alternatively, dexamethasone is administered as four 6 mg doses every 12 hours.
Potential Side Effects:
- Maternal hyperglycemia, requiring careful monitoring in diabetic patients.
- Temporary reduction in fetal movement, which resolves post-treatment.
Nursing Responsibilities:
- Educate the patient about the purpose and short-term nature of side effects.
- Monitor blood glucose levels in diabetic mothers.
Evaluate the use of heparin in pregnant women with thrombophilia. Discuss the advantages, monitoring requirements, and nursing responsibilities.
Answer:
Heparin is the anticoagulant of choice during pregnancy for managing conditions such as thrombophilia and venous thromboembolism (VTE).
Advantages:
- Does not cross the placenta, making it safe for the fetus.
- Effectively reduces the risk of clot formation without causing teratogenic effects.
Monitoring Requirements:
- Monitor activated partial thromboplastin time (aPTT) to ensure therapeutic levels.
- Regularly assess for signs of bleeding or bruising.
Nursing Responsibilities:
- Educate the patient on self-administration techniques for subcutaneous low molecular weight heparin (LMWH).
- Monitor for side effects such as heparin-induced thrombocytopenia (HIT) or osteoporosis with prolonged use.
Discuss the role of pain management medications during labor, including the benefits and risks of epidural analgesia.
Answer:
Pain management is a critical aspect of labor care, with epidural analgesia being one of the most common methods used.
Benefits of Epidural Analgesia:
- Provides effective pain relief while allowing the mother to remain awake and actively participate in labor.
- Can be adjusted to provide adequate pain control without complete motor block.
Risks of Epidural Analgesia:
- Hypotension due to sympathetic blockade, which may affect uteroplacental blood flow.
- Potential for prolonged labor and increased use of operative delivery.
- Rare complications include infection, spinal headache, or nerve damage.
Nursing Responsibilities:
- Monitor maternal blood pressure and fetal heart rate closely during administration.
- Educate the patient about potential side effects and provide reassurance.
Describe the use of aspirin in the prevention of preeclampsia. Include evidence supporting its use and nursing responsibilities.
Answer:
Low-dose aspirin is recommended for preeclampsia prevention in high-risk pregnancies.
Evidence Supporting Its Use:
- Studies show that aspirin reduces the risk of preeclampsia by inhibiting platelet aggregation and improving uteroplacental blood flow.
- It is particularly effective when initiated before 16 weeks of gestation.
Nursing Responsibilities:
- Educate patients on the importance of adherence to low-dose aspirin (81 mg daily).
- Monitor for signs of bleeding, particularly in patients with a history of bleeding disorders.
- Assess for contraindications such as aspirin allergy or gastrointestinal issues.
Discuss the challenges and solutions in administering antiretroviral therapy (ART) to pregnant women with HIV.
Answer:
Antiretroviral therapy (ART) is essential to reduce maternal viral load and prevent vertical transmission of HIV.
Challenges:
- Medication adherence may be difficult due to side effects such as nausea and fatigue.
- Concerns about potential teratogenicity of some ART drugs.
- Drug-drug interactions with other medications used in pregnancy.
Solutions:
- Select ART regimens that are proven safe and effective during pregnancy, such as tenofovir/emtricitabine and raltegravir.
- Provide comprehensive counseling to address fears and ensure adherence.
- Regularly monitor maternal viral load and fetal development through ultrasounds and lab tests.
Nursing Responsibilities:
- Educate patients on the importance of adherence to prevent vertical transmission.
- Monitor for side effects and intervene promptly if issues arise.