NARM Pharmacology and Medications 3 — Questions and Answers
Question 1: A client at 41 weeks requires cervical ripening. Misoprostol (Cytotec) 25 mcg is placed vaginally. How frequently can doses be repeated if needed?
- Every 1 hour
- Every 3–4 hours (Correct answer)
- Every 6 hours
- Every 12 hours
Correct answer: Every 3–4 hours
Vaginal misoprostol 25 mcg may be repeated every 3–4 hours per ACOG protocol, with reassessment of fetal status before each dose.
Question 2: Which finding indicates magnesium toxicity requiring immediate intervention?
- Urinary output of 35 mL/hour
- Absent deep tendon reflexes (Correct answer)
- Respiratory rate of 14 breaths/minute
- Serum magnesium level of 5 mEq/L
Correct answer: Absent deep tendon reflexes
Loss of deep tendon reflexes is the earliest clinical sign of magnesium toxicity and indicates serum levels approaching the toxic range (>7 mEq/L).
Question 3: A newborn is born to a mother who received meperidine (Demerol) 2 hours before delivery. The neonate shows respiratory depression. What medication should be administered?
- Flumazenil 0.01 mg/kg IV
- Naloxone 0.1 mg/kg IM or IV (Correct answer)
- Epinephrine 0.1 mL/kg IV
- Atropine 0.02 mg/kg IV
Correct answer: Naloxone 0.1 mg/kg IM or IV
Naloxone (Narcan) is the opioid antagonist used to reverse neonatal respiratory depression caused by maternal opioid administration.
Question 4: Which herbal supplement is CONTRAINDICATED in pregnancy due to its uterotonic properties?
- Ginger (Zingiber officinale) in food amounts
- Blue cohosh (Caulophyllum thalictroides) (Correct answer)
- Red raspberry leaf tea
- Chamomile tea
Correct answer: Blue cohosh (Caulophyllum thalictroides)
Blue cohosh contains caulosaponin and caulophyllosaponin, which have uterotonic and vasoconstrictive effects and are associated with neonatal heart failure.
Question 5: A client has a penicillin allergy documented as 'anaphylaxis.' Which antibiotic should be used for GBS prophylaxis after confirming susceptibility?
- Amoxicillin 500 mg PO q8h
- Cefazolin 2 g IV then 1 g q8h
- Clindamycin 900 mg IV q8h (Correct answer)
- Vancomycin 20 mg/kg IV q8h
Correct answer: Clindamycin 900 mg IV q8h
For clients with high-risk penicillin allergy (anaphylaxis, angioedema, urticaria), clindamycin is used if the GBS isolate is susceptible; cefazolin is used only for low-risk penicillin allergy.
Question 6: Rho(D) immune globulin (RhoGAM) is administered at 28 weeks to an Rh-negative client. When must it be administered again postpartum?
- Only if the baby is Rh-positive, within 72 hours of birth (Correct answer)
- Regardless of infant blood type, within 24 hours
- Only if the baby is Rh-negative, within 72 hours
- At 6 weeks postpartum regardless of infant blood type
Correct answer: Only if the baby is Rh-positive, within 72 hours of birth
A postpartum dose of Rho(D) immune globulin is required only when the neonate is Rh-positive (or Rh-unknown), and must be given within 72 hours of delivery.
Question 7: Which statement about oxytocin's pharmacokinetics during labor augmentation is accurate?
- Steady-state plasma levels are achieved within 5 minutes of starting infusion
- Oxytocin has a half-life of approximately 3–5 minutes (Correct answer)
- Dose increments should occur every 15–30 minutes to allow for steady state
- Oxytocin crosses the placenta and directly stimulates fetal myometrium
Correct answer: Oxytocin has a half-life of approximately 3–5 minutes
Oxytocin has a half-life of 3–5 minutes, and steady-state levels are achieved in approximately 20–40 minutes after initiating or changing infusion rates.
NARM Pharmacology and Medications 3
A client at 41 weeks requires cervical ripening.
Misoprostol (Cytotec) 25 mcg is placed vaginally.
How frequently can doses be repeated if needed?