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Questions and Answers
A postpartum patient with a history of well-controlled asthma experiences a PPH. Which uterotonic medication is most appropriate, considering their medical history?
A postpartum patient with a history of well-controlled asthma experiences a PPH. Which uterotonic medication is most appropriate, considering their medical history?
- Misoprostol (Cytotec) (correct)
- Methylergonovine (Methergine)
- Carboprost (Hemabate)
- Tranexamic Acid (TXA)
A mother is Rh negative antibody negative and her baby is Rh positive. She asks why you want to give her another injection after birth when she already received Rhogam during her pregnancy. What is the correct response?
A mother is Rh negative antibody negative and her baby is Rh positive. She asks why you want to give her another injection after birth when she already received Rhogam during her pregnancy. What is the correct response?
- To prevent future miscarriages from occuring
- To prevent an anaphylactic reaction from occuring after delivery.
- To provide her baby with the necessary antibodies that she could not produce during the pregnancy.
- To prevent the development of alloimmunization after exposure to fetal Rh-positive red blood cells during delivery. (correct)
A newborn is diagnosed with late-onset hemorrhagic disease of the newborn (HDN) at three weeks of age. Which of the following factors most likely contributed to this condition?
A newborn is diagnosed with late-onset hemorrhagic disease of the newborn (HDN) at three weeks of age. Which of the following factors most likely contributed to this condition?
- Maternal history of gestational diabetes.
- Delayed cord clamping at birth.
- Routine circumcision without proper analgesia.
- Exclusive breastfeeding without Vitamin K supplementation. (correct)
In which of the following scenarios would administering the Rubella vaccine (MMR) be most inappropriate?
In which of the following scenarios would administering the Rubella vaccine (MMR) be most inappropriate?
A newborn requires eye prophylaxis to prevent ophthalmia neonatorum. If parents refuse eye prophylaxis due to religious reasons, what is the most appropriate next step for the nurse?
A newborn requires eye prophylaxis to prevent ophthalmia neonatorum. If parents refuse eye prophylaxis due to religious reasons, what is the most appropriate next step for the nurse?
In maternal-child health, what is the primary reason for the heightened importance of the 'right reason' principle in medication administration?
In maternal-child health, what is the primary reason for the heightened importance of the 'right reason' principle in medication administration?
Why are independent nurse double checks particularly critical for pediatric medication administration?
Why are independent nurse double checks particularly critical for pediatric medication administration?
A nurse is about to administer a high-risk medication. According to protocol, what step must be taken before administration?
A nurse is about to administer a high-risk medication. According to protocol, what step must be taken before administration?
A nurse wastes a partial dose of a narcotic. What procedure must be followed to maintain the chain of custody?
A nurse wastes a partial dose of a narcotic. What procedure must be followed to maintain the chain of custody?
A physician orders a medication for a pregnant patient, but the nurse is unsure about the safety of the medication during pregnancy. What is the MOST appropriate action for the nurse to take?
A physician orders a medication for a pregnant patient, but the nurse is unsure about the safety of the medication during pregnancy. What is the MOST appropriate action for the nurse to take?
During intrapartum care, a patient is prescribed Penicillin G for GBS prophylaxis. The patient reports burning at the IV site during administration. What is the nurse's priority action?
During intrapartum care, a patient is prescribed Penicillin G for GBS prophylaxis. The patient reports burning at the IV site during administration. What is the nurse's priority action?
A laboring patient who is GBS positive received Penicillin every 4 hours during labor and delivered vaginally. The baby now has elevated temperature and lethargy. What action is MOST important?
A laboring patient who is GBS positive received Penicillin every 4 hours during labor and delivered vaginally. The baby now has elevated temperature and lethargy. What action is MOST important?
A patient is receiving cefazolin (Ancef) as surgical prophylaxis prior to a cesarean section. Which nursing intervention is MOST important to prevent potential adverse reactions?
A patient is receiving cefazolin (Ancef) as surgical prophylaxis prior to a cesarean section. Which nursing intervention is MOST important to prevent potential adverse reactions?
A nurse is caring for a patient receiving magnesium sulfate. Which assessment finding requires immediate intervention?
A nurse is caring for a patient receiving magnesium sulfate. Which assessment finding requires immediate intervention?
A patient with preterm labor at 31 weeks gestation is prescribed indomethacin. What information should the nurse consider before administering this medication?
A patient with preterm labor at 31 weeks gestation is prescribed indomethacin. What information should the nurse consider before administering this medication?
A patient receiving oxytocin for labor augmentation exhibits frequent, prolonged uterine contractions and signs of fetal distress. What is the priority nursing intervention?
A patient receiving oxytocin for labor augmentation exhibits frequent, prolonged uterine contractions and signs of fetal distress. What is the priority nursing intervention?
Following the delivery of an Rh-positive infant, an Rh-negative mother is to receive RhoGAM. Which action is most important for the nurse to take before administering the medication?
Following the delivery of an Rh-positive infant, an Rh-negative mother is to receive RhoGAM. Which action is most important for the nurse to take before administering the medication?
A patient in preterm labor is prescribed betamethasone. Which condition should the nurse monitor the patient for?
A patient in preterm labor is prescribed betamethasone. Which condition should the nurse monitor the patient for?
When caring for a patient receiving a continuous epidural infusion, which nursing intervention is most crucial to prevent fetal malposition?
When caring for a patient receiving a continuous epidural infusion, which nursing intervention is most crucial to prevent fetal malposition?
Which medication used to ripen the cervix is contraindicated in a patient with a history of prior uterine scarring?
Which medication used to ripen the cervix is contraindicated in a patient with a history of prior uterine scarring?
A patient receiving terbutaline reports feeling like they've had "several cups of caffeine". What is the priority nursing intervention?
A patient receiving terbutaline reports feeling like they've had "several cups of caffeine". What is the priority nursing intervention?
Which assessment finding indicates magnesium sulfate toxicity?
Which assessment finding indicates magnesium sulfate toxicity?
Which of the following is the most appropriate initial nursing intervention for a patient experiencing hypotension after epidural placement?
Which of the following is the most appropriate initial nursing intervention for a patient experiencing hypotension after epidural placement?
A patient at 40 weeks gestation with a Bishop score of 6 is scheduled for an elective induction of labor. What information should the nurse provide the patient?
A patient at 40 weeks gestation with a Bishop score of 6 is scheduled for an elective induction of labor. What information should the nurse provide the patient?
Which medication requires the most stringent double-check verification process due to its high-risk nature in labor and delivery?
Which medication requires the most stringent double-check verification process due to its high-risk nature in labor and delivery?
A patient with known vitamin B12 deficiency is requesting nitrous oxide for labor pain management. Which action should the nurse do?
A patient with known vitamin B12 deficiency is requesting nitrous oxide for labor pain management. Which action should the nurse do?
After administering a dose of opioid pain medication, what is the most important nursing action?
After administering a dose of opioid pain medication, what is the most important nursing action?
Which medication, commonly used for blood pressure control in gestational hypertension, is also utilized as a tocolytic?
Which medication, commonly used for blood pressure control in gestational hypertension, is also utilized as a tocolytic?
Flashcards
Eight Rights of Medication Administration
Eight Rights of Medication Administration
Ensuring the right medication is given to the right patient, in the right dose, via the right route, at the right time, with the right documentation, for the right reason, and monitoring for the right response.
Five Foundational Medication Questions
Five Foundational Medication Questions
A systematic approach to medication safety, involving understanding the drug class, indication, patient-specific rationale, expected response, necessary assessments, and dose safety.
High-Alert Medications
High-Alert Medications
Medications with a heightened risk of causing significant patient harm if used incorrectly.
Off-label Use
Off-label Use
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Teratogenic
Teratogenic
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Tocolytic
Tocolytic
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Uterotonic
Uterotonic
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GBS Prophylaxis
GBS Prophylaxis
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Methylergonovine (Methergine)
Methylergonovine (Methergine)
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Hemabate (Carboprost)
Hemabate (Carboprost)
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Tranexamic Acid (TXA)
Tranexamic Acid (TXA)
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Erythromycin Eye Ointment
Erythromycin Eye Ointment
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Vitamin K for Newborns
Vitamin K for Newborns
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Nifedipine (Procardia)
Nifedipine (Procardia)
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Indomethacin (Indocin) Contraindication
Indomethacin (Indocin) Contraindication
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Corticosteroids in Preterm Labor
Corticosteroids in Preterm Labor
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Cervical Ripening Agents
Cervical Ripening Agents
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Bishop Score
Bishop Score
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Opioids and Newborns
Opioids and Newborns
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Nitrous Oxide in Labor
Nitrous Oxide in Labor
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Hypotension with Epidural/Spinal
Hypotension with Epidural/Spinal
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Co-loading Fluids
Co-loading Fluids
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Oxytocin (Pitocin)
Oxytocin (Pitocin)
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Oxytocin risk
Oxytocin risk
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Oxytocin Standard Concentration
Oxytocin Standard Concentration
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Antihypertensives in Pregnancy
Antihypertensives in Pregnancy
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RhoGAM
RhoGAM
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Study Notes
Medication Administration: Eight Rights in Maternal-Child Health (MCH)
- Eight Rights include: right patient, medication, dose, route, time, documentation, reason, and response.
- Right reason is especially important in MCH due to off-label medication use.
- Right response involves monitoring for the intended effect of the medication.
- MCH frequently involves off-label medication use.
- All medications for pediatric patients require independent nurse double checks to minimize risk.
- High-risk medications, as labeled by the pharmacy, always need independent RN double checks.
- Wasted narcotics require a witness by another nurse to ensure the chain of custody isn't broken.
- Independent nurse double check: Each nurse performs the eight rights independently, preventing errors.
- Nurses must know identifiers used to confirm the patient like name and birth date.
Five Foundational Medication Questions (Keith RN, 2018)
- Help ensure safe medication administration.
- Questions include: pharmacological class, medication indication, reason for use in the patient, expected response, assessments needed, and dose safety.
- Nurses are patient advocates, verifying medication orders, dosages, and administration.
- Medical errors can occur at any point in the medication process.
Key Medication Definitions
- High Alert: Medications with a high risk of causing significant patient harm.
- Off-label Use: Using a drug for a purpose not approved by the FDA, common in MCH.
- Cytotec is FDA-approved for gastric ulcers but used off-label to induce uterine contractions.
- Teratogenic: Causing irreversible structural or functional changes, especially during pregnancy.
- Tocolytic: A drug used to suppress or inhibit labor.
- Uterotonic: A drug used to stimulate uterine contractions.
Antibiotics in Antipartum/Intrapartum Care
- Focus on safety for both mother and baby.
GBS Prophylaxis
- Group B Streptococcus (GBS) colonization, not infection, is screened via swab.
- Colonization can lead to GBS sepsis in newborns.
- Penicillin G is the preferred antibiotic.
- Penicillin G can cause burning at the IV site so ensure proper IV placement, consider warmth.
- At least two doses are recommended before delivery, ideally four hours apart.
- Watch for signs of sepsis in newborns even with prophylaxis.
Surgical Prophylaxis
- Facility-specific options include cefazolin (Ancef), gentamicin, or clindamycin.
- It is important for nurses to know pre-surgical antibiotic orders.
Confirmed/Suspected Sepsis
- Antibiotics safe for pregnancy/postpartum are used.
Tocolytics
- Used to stop contractions.
Nifedipine (Procardia)
- Calcium channel blocker and smooth muscle relaxant.
- Used to slow preterm labor.
- Contraindicated in myasthenia gravis.
- Check blood pressure and pulse before administration.
Indomethacin (Indocin)
- Contraindicated at or after 32 weeks gestation due to risk of premature closure of the fetal ductus arteriosus.
- Used before 32 weeks gestation to suppress preterm labor.
Terbutaline
- Subcutaneous injection (0.25 mg).
- Can cause significant side effects like shortness of breath, tachycardia, palpitations, tremors, headaches.
- Check pulse before administering, facility might set pulse parameters.
- Usually a maximum of two doses.
- Comes as 1 mg/1 mL vial, so proper dosage calculation is critical.
Magnesium Sulfate
- The current thinking is that it is not a great tocolytic.
- Used for neuroprotection of the premature baby.
- Side effects: headache, nausea, vomiting, dizziness, flushing, sweating, hypotension.
- Loading dose: 4-6 grams over 20-30 minutes (high risk, requires close monitoring).
- Adverse effects: respiratory depression, depressed reflexes, muscle weakness, decreased urine output.
- Monitor respiratory rate, reflexes, urine output, and lung sounds frequently (every 1-2 hours).
- Magnesium toxicity: respiratory failure/arrest, heart block.
- Magnesium sulfate does decrease blood pressure, but that's not why it's used in pre-eclamptic patients.
- Reflexes are the first sign of toxicity.
- Magnesium sulfate is cleared renally; decreased urine output increases toxicity risk.
- Therapeutic level: 6-8 mg/dL, above this increases the risk of toxicity.
- Contraindicated in myasthenia gravis, hypocalcemia, heart block, and renal failure.
- Calcium gluconate is the antidote; keep readily available.
Corticosteroids
- Given to mothers to increase surfactant production in the fetus.
- Typically used between 24-34 weeks, but some evidence suggests up to 39 weeks.
- Betamethasone: two doses, 24 hours apart.
- Dexamethasone: four doses, every 12 hours.
- Potential side effects: increased white blood cell count, pulmonary edema, and elevated blood glucose levels, especially in diabetic mothers.
Prostaglandins
- Misoprostol (Cytotec) and dinoprostone (Cervidil) ripen the cervix to prepare for labor.
- Cervidil: a 12-hour tampon inserted vaginally.
- Cytotec: oral, vaginal, or rectal tablet given in small doses to ripen the cervix with gentle contractions.
- Used sequentially.
- Induction is an accelerated process; medical inductions are for the well-being of the baby.
- Elective inductions should only be done after assessing Bishop score; not recommended until Bishop Score is 8 or more.
- Contraindicated when vaginal delivery is not indicated like in cases of fetal malpresentation, and prior uterine scarring.
Pain Medications: Opioids
- Cause respiratory depression in newborns.
- Stadol: Longer acting; useful in prodromal labor, not for imminent delivery.
- Nubain: Effective for some providers, provider specific dose.
- Fentanyl: 50-100 mcg, maximum of six doses.
- Opioids won't take labor pain away, instead they relax and take off the edge.
- Dilaudid/Demerol: Infrequently used.
- All have the potential for respiratory depression/arrest in mother and newborn if given close to delivery.
Sedation Scale
- Used to assess opioid effects.
- Helps determine whether another dose is safe based on level of drowsiness/arousal.
Nitrous Oxide
- "Laughing gas" for anxiety and relaxation, not pain relief.
- Patient-controlled via mask, effects clear within 60 seconds of mask removal.
- No known newborn effects.
- Caution in vitamin B12 deficiency.
Epidural and Spinal Anesthesia
- Epidural: Catheter placed for continuous medication infusion.
- Spinal: One-time injection, no catheter.
- Side effect: Hypotension due to vasodilation.
- Counteract hypotension with fluid bolus.
- Other side effects: nausea/vomiting (related to hypotension) and itching.
Nursing Interventions: Epidural/Spinal
- Co-load crystalloid fluids.
- Monitor fetal heart rate and maternal blood pressure closely until stable.
- Monitor for bladder distension.
- Monitor oxygen saturation.
- Frequent maternal repositioning (every 20-30 minutes) to prevent fetal malposition.
Uterotonics: Oxytocin (Pitocin)
Labor Use
- Standard concentration: 30 units in 500 mLs.
- High-risk medication requiring double checks.
- Number one cause of harm to the baby.
- Strict policies, monitoring, and quick cessation with fetal distress are key.
Postpartum Use
- Larger doses than in labor.
- Recommended dosage: 10 units over 30 minutes, infused over 3.5 hours.
- Avoid bolus administration.
- Contraindicated if a patient has hypertonic uterine contractions.
- Post-delivery it will contract the uterus quickly.
Nursing Interventions: Oxytocin
- Continuous fetal monitoring during labor.
- Frequent vital sign checks postpartum.
Antihypertensives
- Guidelines vary by facility; many are adopting standardized gestational hypertension protocols.
- Labetalol, hydralazine, and nifedipine (Procardia) are common choices.
- Dosages based on CMQCC recommendations.
- Closely monitor vital signs and avoid exceeding maximum dosages.
RhoGAM
- Given to Rh-negative mothers who deliver Rh-positive babies.
- Prevents antibody formation that could affect future pregnancies.
- Also given in cases of potential blood exposure: amniocentesis, CVS, transfusion, termination, trauma, bleeding.
- Requires informed consent.
Postpartum Medications: Uterotonics
- Oxytocin (Pitocin): Used both antipartum and postpartum.
Hemorrhage Toolkit
- Methylergonovine (Methergine): Injection; contraindicated in hypertensive patients to avoid stroke.
- Hemabate (Carboprost): Injection; contraindicated in asthma patients.
- Tranexamic Acid (TXA): IV injection.
- Misoprostol (Cytotec): Larger doses for postpartum hemorrhage control.
- Quantitative measurement of vaginal bleeding (weighing) is essential.
Vaccines During and After Pregnancy
- Highly recommended because the immunity from the transfer.
Third Trimester
- Flu vaccine.
- Tdap (whooping cough).
After Birth
- Rubella vaccine (MMR) if non-immune; avoid pregnancy for three months after due to live virus.
Egg Allergies
- No longer a contraindication to vaccination per current CDC guidelines.
Newborn Medications
- Eye Prophylaxis (Erythromycin):
- Prevents ophthalmia neonatorum (gonorrhea/chlamydia); it is required in all 50 states, but refusal is possible.
- Parents will sign a form ensuring they understand why the medication is given and what to look for.
Vitamin K
- Helps with the synthesis of Pro-Thrombin for clotting
- Given in all 50 states to prevent hemorrhagic disease.
- Not efficiently synthesized in newborns, especially breastfed babies.
Hepatitis B Vaccine
- Option to start the series at birth.
- Requires informed consent (benefits, risks, alternatives).
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