Obstetric Nurse Test Obstetric Nurse Pharmacology in Obstetrics 3 — Questions and Answers
Question 1: A laboring patient is receiving epidural bupivacaine. She suddenly reports ringing in her ears and a metallic taste. What does the nurse suspect?
- Local anesthetic systemic toxicity (LAST) (Correct answer)
- Spinal headache
- Hypoglycemia
- Opioid side effect
Correct answer: Local anesthetic systemic toxicity (LAST)
Tinnitus and metallic taste are early CNS signs of local anesthetic systemic toxicity from inadvertent intravascular injection.
Question 2: Terbutaline is prescribed as a tocolytic. For which patient condition would this drug be most hazardous?
- Gestational diabetes (Correct answer)
- Mild preeclampsia
- Iron deficiency anemia
- Group B Strep colonization
Correct answer: Gestational diabetes
Terbutaline is a beta-2 agonist that causes hyperglycemia, making it particularly dangerous in patients with diabetes who require careful glucose management.
Question 3: A nurse administers vitamin K (phytonadione) to a newborn. What is the rationale for this injection?
- Prevent neonatal hypoglycemia
- Prevent hemorrhagic disease of the newborn (Correct answer)
- Provide passive immunity
- Stimulate bone marrow production
Correct answer: Prevent hemorrhagic disease of the newborn
Newborns have insufficient intestinal bacteria to synthesize vitamin K, placing them at risk for hemorrhagic disease without prophylactic administration.
Question 4: Which medication given in labor can cause neonatal respiratory depression and is best avoided within 4 hours of anticipated delivery?
- Fentanyl IV
- Butorphanol (Stadol)
- Meperidine (Demerol) (Correct answer)
- Promethazine
Correct answer: Meperidine (Demerol)
Meperidine has an active metabolite (normeperidine) that accumulates and causes prolonged neonatal respiratory depression; its peak neonatal effect occurs 2–4 hours after maternal administration.
Question 5: A patient at 37 weeks with severe preeclampsia is started on IV labetalol for blood pressure control. Which assessment finding should prompt the nurse to hold the dose?
- Maternal heart rate of 52 bpm (Correct answer)
- Blood pressure of 158/104 mmHg
- Fetal heart rate of 140 bpm
- Urine output of 40 mL/hr
Correct answer: Maternal heart rate of 52 bpm
Labetalol is a beta-blocker that can cause bradycardia; a maternal heart rate below 60 bpm is a contraindication to administering the next dose.
Question 6: Dinoprostone (Cervidil) cervical ripening insert is placed at 8 AM. At what point must it be removed?
- After 6 hours or with onset of active labor
- After 12 hours or with onset of active labor (Correct answer)
- After 24 hours or with onset of active labor
- Only when oxytocin infusion is started
Correct answer: After 12 hours or with onset of active labor
Cervidil is designed for up to 12 hours of use and must be removed at the onset of active labor or if uterine hyperstimulation occurs.
Question 7: A nurse is teaching a patient about taking iron supplements prescribed during pregnancy. Which instruction is most important for maximizing absorption?
- Take with a glass of milk to protect the stomach
- Take with vitamin C such as orange juice (Correct answer)
- Take with a calcium supplement for synergy
- Take immediately after a full meal
Correct answer: Take with vitamin C such as orange juice
Vitamin C (ascorbic acid) converts ferric iron to the ferrous form, significantly enhancing non-heme iron absorption in the gastrointestinal tract.
Obstetric Nurse Test Obstetric Nurse Pharmacology in Obstetrics 3
A laboring patient is receiving epidural bupivacaine.
She suddenly reports ringing in her ears and a metallic taste.
What does the nurse suspect?