Maternal Newborn Nursing Test Pharmacology in Maternal-Newborn Nursing 2 — Questions and Answers
Question 1: A patient with preeclampsia is receiving magnesium sulfate 2 g/hr IV. The nurse notes the deep tendon reflexes are absent. What is the priority nursing action?
- Increase the magnesium infusion rate to prevent seizures
- Stop the infusion and administer calcium gluconate IV (Correct answer)
- Document the finding and continue monitoring
- Notify the charge nurse and obtain a repeat blood pressure
Correct answer: Stop the infusion and administer calcium gluconate IV
Absent deep tendon reflexes indicate magnesium toxicity (levels typically >7 mEq/L); the infusion must be stopped immediately and calcium gluconate 1 g IV administered as the antidote.
Question 2: A patient at 32 weeks gestation with a placenta previa has received betamethasone 12 mg IM. When should the second dose be administered?
- 12 hours after the first dose
- 24 hours after the first dose (Correct answer)
- 48 hours after the first dose
- 72 hours after the first dose
Correct answer: 24 hours after the first dose
The standard antenatal corticosteroid regimen for betamethasone is two doses of 12 mg IM given 24 hours apart to achieve optimal fetal lung maturation.
Question 3: A patient receives terbutaline for preterm labor. Which maternal side effect requires the nurse to notify the healthcare provider immediately?
- Mild tremors and palpitations
- Heart rate of 130 bpm with chest pain (Correct answer)
- Mild headache and facial flushing
- Transient nausea and diaphoresis
Correct answer: Heart rate of 130 bpm with chest pain
Tachycardia above 120 bpm with chest pain may indicate cardiac dysrhythmia or pulmonary edema, serious complications of terbutaline that require immediate medical evaluation.
Question 4: A postpartum patient requires methylergonovine (Methergine) for uterine atony after vaginal delivery. Which condition is an absolute contraindication?
- Breastfeeding
- Gestational age less than 37 weeks
- Hypertension with blood pressure of 160/110 mmHg (Correct answer)
- Previous cesarean delivery
Correct answer: Hypertension with blood pressure of 160/110 mmHg
Methylergonovine causes vasoconstriction and is absolutely contraindicated in hypertensive patients because it can precipitate severe hypertension, stroke, or myocardial infarction.
Question 5: A newborn is diagnosed with neonatal abstinence syndrome. Morphine is ordered to treat withdrawal symptoms. What is the primary nursing assessment during this treatment?
- Monitor blood pressure every 15 minutes
- Use a validated NAS scoring tool (such as Finnegan) to titrate morphine dose (Correct answer)
- Check blood glucose levels every hour
- Perform daily ECG monitoring for QT prolongation
Correct answer: Use a validated NAS scoring tool (such as Finnegan) to titrate morphine dose
The Finnegan Neonatal Abstinence Scoring Tool or similar validated instrument quantifies withdrawal symptom severity and guides morphine dose titration during NAS pharmacotherapy.
Question 6: A 34-week neonate is started on caffeine citrate for apnea of prematurity. What is the primary mechanism of action?
- Inhibits adenosine receptors in the brainstem to stimulate respiratory drive (Correct answer)
- Stimulates surfactant production in type II pneumocytes
- Causes bronchodilation by relaxing smooth muscle
- Activates dopamine receptors to increase heart rate
Correct answer: Inhibits adenosine receptors in the brainstem to stimulate respiratory drive
Caffeine citrate works by blocking adenosine receptors in the brainstem respiratory centers, increasing sensitivity to CO2 and stimulating respiratory effort to reduce apneic episodes.
