NARM Pharmacology and Medications 2 — Questions and Answers
Question 1: A client at 38 weeks gestation has a postpartum hemorrhage risk. Which medication is the FIRST-LINE uterotonic recommended by ACOG and used by CPMs within their scope?
- Misoprostol 600 mcg sublingual
- Oxytocin 10 units IM (Correct answer)
- Methylergonovine 0.2 mg IM
- Carboprost 250 mcg IM
Correct answer: Oxytocin 10 units IM
Oxytocin 10 units IM is the first-line uterotonic for postpartum hemorrhage prevention and treatment per ACOG guidelines.
Question 2: When administering Vitamin K (phytonadione) to a newborn, what is the correct intramuscular dose?
- 0.1 mg
- 0.5 mg
- 1 mg (Correct answer)
- 2 mg
Correct answer: 1 mg
The standard prophylactic dose of Vitamin K1 for newborns is 1 mg IM, given within 6 hours of birth.
Question 3: A client reports she took metformin throughout pregnancy for type 2 diabetes. Which neonatal complication should the midwife monitor for immediately after birth?
- Hypercalcemia
- Hypoglycemia (Correct answer)
- Respiratory alkalosis
- Polycythemia
Correct answer: Hypoglycemia
Neonates born to mothers on metformin or insulin are at risk for hypoglycemia due to fetal hyperinsulinism responding to maternal glucose levels.
Question 4: Which antibiotic is the standard prophylaxis given to GBS-positive clients in labor when they have no penicillin allergy?
- Clindamycin 900 mg IV
- Ampicillin 2 g IV then 1 g q4h
- Cefazolin 2 g IV then 1 g q8h
- Penicillin G 5 million units IV then 2.5 million units q4h (Correct answer)
Correct answer: Penicillin G 5 million units IV then 2.5 million units q4h
Penicillin G is the preferred agent for GBS intrapartum prophylaxis per CDC guidelines due to its narrow spectrum.
Question 5: A midwife administers erythromycin ophthalmic ointment to a newborn. What is the primary purpose of this prophylaxis?
- Prevention of chlamydial and gonococcal conjunctivitis (Correct answer)
- Treatment of herpes simplex keratitis
- Prevention of cytomegalovirus retinitis
- Treatment of chemical conjunctivitis
Correct answer: Prevention of chlamydial and gonococcal conjunctivitis
Erythromycin 0.5% ophthalmic ointment is applied to prevent ophthalmia neonatorum caused by Neisseria gonorrhoeae and Chlamydia trachomatis.
Question 6: A breastfeeding client asks if she can take ibuprofen for afterpains. Which statement reflects the best evidence-based guidance?
- Ibuprofen is contraindicated in breastfeeding mothers
- Ibuprofen is compatible with breastfeeding as minimal amounts transfer into breast milk (Correct answer)
- Ibuprofen should be replaced with aspirin for breastfeeding mothers
- Ibuprofen use requires a 4-hour pump-and-discard period
Correct answer: Ibuprofen is compatible with breastfeeding as minimal amounts transfer into breast milk
Ibuprofen is considered safe during breastfeeding because it has low oral bioavailability and minimal transfer into breast milk.
Question 7: What is the mechanism of action of magnesium sulfate when used for eclampsia prophylaxis?
- Blocks calcium channels in smooth muscle, reducing blood pressure
- Inhibits prostaglandin synthesis, reducing neuroinflammation
- Stabilizes neuronal membranes by competing with calcium at receptor sites (Correct answer)
- Enhances GABA activity to produce CNS sedation
Correct answer: Stabilizes neuronal membranes by competing with calcium at receptor sites
Magnesium sulfate prevents seizures by competing with calcium at N-methyl-D-aspartate (NMDA) receptors, stabilizing neuronal membrane excitability.
NARM Pharmacology and Medications 2
A client at 38 weeks gestation has a postpartum hemorrhage risk.
Which medication is the FIRST-LINE uterotonic recommended by ACOG and used by CPMs within their scope?