Maternal Newborn Nursing Test Pharmacology in Maternal-Newborn Nursing 1 — Questions and Answers
Question 1: A patient at 28 weeks gestation is in preterm labor. Betamethasone is ordered. What is the primary purpose of this medication?
- To stop uterine contractions and prevent preterm birth
- To accelerate fetal lung maturity and surfactant production (Correct answer)
- To treat Group B Streptococcus infection
- To prevent postpartum hemorrhage after delivery
Correct answer: To accelerate fetal lung maturity and surfactant production
Antenatal betamethasone (corticosteroid) given between 24–34 weeks gestation promotes fetal surfactant production, reducing the severity of respiratory distress syndrome after preterm birth.
Question 2: A patient at 30 weeks gestation in preterm labor receives nifedipine as a tocolytic. Which side effect should the nurse monitor for?
- Hypertension and bradycardia
- Hypotension, flushing, and headache (Correct answer)
- Bronchoconstriction and dyspnea
- Hyperglycemia and urinary retention
Correct answer: Hypotension, flushing, and headache
Nifedipine, a calcium channel blocker used as a tocolytic, causes vasodilation resulting in hypotension, flushing, and headache as its primary side effects.
Question 3: A postpartum patient is receiving oxytocin (Pitocin) IV for uterine atony. Which adverse effect is specific to high-dose oxytocin administration?
- Hypertension and tachycardia
- Water intoxication and hyponatremia (Correct answer)
- Hyperkalemia and peaked T-waves
- Respiratory alkalosis
Correct answer: Water intoxication and hyponatremia
Oxytocin has antidiuretic properties similar to ADH; at high doses or with large fluid volumes, it can cause water retention leading to hyponatremia and water intoxication.
Question 4: A Rh-negative mother delivers an Rh-positive baby. Rho(D) immune globulin (RhoGAM) is ordered. Within what time frame should it be administered?
- Within 12 hours of delivery
- Within 24 hours of delivery
- Within 72 hours of delivery (Correct answer)
- Within 1 week of delivery
Correct answer: Within 72 hours of delivery
RhoGAM must be administered within 72 hours of delivery to prevent Rh sensitization in Rh-negative mothers; it works by clearing fetal Rh-positive cells before they trigger maternal antibody production.
Question 5: A newborn requires resuscitation in the delivery room. Epinephrine is administered via the endotracheal tube. What is the correct dose range?
- 0.01–0.03 mg/kg of 1:1,000 concentration
- 0.01–0.03 mg/kg of 1:10,000 concentration via IV/IO (0.05–0.1 mg/kg via ETT) (Correct answer)
- 0.1 mg/kg of 1:10,000 concentration
- 0.5 mg/kg of 1:100,000 concentration
Correct answer: 0.01–0.03 mg/kg of 1:10,000 concentration via IV/IO (0.05–0.1 mg/kg via ETT)
Per NRP guidelines, IV/IO epinephrine dose is 0.01–0.03 mg/kg of 1:10,000 solution; the endotracheal dose is higher (0.05–0.1 mg/kg) due to less reliable absorption.
Question 6: A breastfeeding mother is prescribed codeine for postpartum pain. Why is this medication of particular concern for her breastfed infant?
- Codeine is not absorbed through breast milk
- Ultra-rapid metabolizers convert codeine to morphine at higher rates, risking neonatal opioid toxicity (Correct answer)
- Codeine causes maternal hypotension affecting milk production
- Codeine increases neonatal alertness and feeding difficulty
Correct answer: Ultra-rapid metabolizers convert codeine to morphine at higher rates, risking neonatal opioid toxicity
Ultra-rapid CYP2D6 metabolizers convert codeine to morphine faster than normal, leading to dangerously high morphine levels in breast milk that can cause neonatal respiratory depression.
Maternal Newborn Nursing Test Pharmacology in Maternal-Newborn Nursing 1
A patient at 28 weeks gestation is in preterm labor.
Betamethasone is ordered.
What is the primary purpose of this medication?