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.
