Obstetric Nurse Test Obstetric Nurse Pharmacology in Obstetrics 4 — Questions and Answers
Question 1: A patient with a penicillin allergy requires GBS prophylaxis in labor. Which antibiotic is the recommended first alternative?
- Ampicillin
- Clindamycin
- Vancomycin
- Cefazolin (Correct answer)
Correct answer: Cefazolin
Cefazolin is the recommended first-line alternative for GBS prophylaxis in penicillin-allergic patients without high-risk allergy features because cross-reactivity is very low.
Question 2: Indomethacin (Indocin) is used as a tocolytic agent. Which fetal side effect limits its use beyond 32 weeks gestation?
- Fetal bradycardia
- Premature closure of the ductus arteriosus (Correct answer)
- Fetal hyperglycemia
- Fetal limb contractures
Correct answer: Premature closure of the ductus arteriosus
Indomethacin, an NSAID, inhibits prostaglandin synthesis and can cause constriction of the fetal ductus arteriosus, leading to pulmonary hypertension.
Question 3: A postpartum patient is prescribed low-molecular-weight heparin (enoxaparin) for DVT prophylaxis. Which lab value does NOT require routine monitoring with LMWH, unlike unfractionated heparin?
- aPTT (Correct answer)
- Platelet count
- CBC
- Anti-Xa level
Correct answer: aPTT
LMWH has a predictable pharmacokinetic profile and does not require routine aPTT monitoring, which is used to monitor unfractionated heparin therapy.
Question 4: Which medication is used to reverse the effects of opioid-induced neonatal respiratory depression at delivery?
- Flumazenil
- Atropine
- Naloxone (Correct answer)
- Epinephrine
Correct answer: Naloxone
Naloxone (Narcan) is an opioid antagonist that rapidly reverses neonatal respiratory depression caused by transplacental opioid transfer.
Question 5: A patient in active labor has an epidural with a continuous infusion. She develops sudden hypotension. What is the nurse's first intervention?
- Administer ephedrine IV per protocol
- Turn patient to left lateral position and increase IV fluids (Correct answer)
- Notify the anesthesiologist and document
- Apply oxygen via non-rebreather mask
Correct answer: Turn patient to left lateral position and increase IV fluids
Left uterine displacement and IV fluid administration are the initial interventions to treat epidural-induced hypotension by improving venous return and cardiac output.
Question 6: Prostaglandin E1 (misoprostol) given vaginally for labor induction has been placed. How long must the nurse wait before initiating oxytocin if the cervix has not changed?
- 1 hour
- 2 hours
- 4 hours (Correct answer)
- 6 hours
Correct answer: 4 hours
A minimum of 4 hours should elapse after the last dose of vaginal misoprostol before starting oxytocin to avoid uterine tachysystole from additive uterotonic effects.
Question 7: A breastfeeding patient asks the nurse if she can take ibuprofen for postpartum pain. Which response is most accurate?
- Ibuprofen is unsafe for breastfeeding and should be avoided entirely
- Ibuprofen is considered compatible with breastfeeding due to minimal transfer into breast milk (Correct answer)
- Ibuprofen transfers significantly into breast milk and requires pumping and dumping
- Acetaminophen must always be used instead of NSAIDs during lactation
Correct answer: Ibuprofen is considered compatible with breastfeeding due to minimal transfer into breast milk
Ibuprofen has low transfer into breast milk and is considered one of the preferred analgesics for breastfeeding mothers by the American Academy of Pediatrics.
Obstetric Nurse Test Obstetric Nurse Pharmacology in Obstetrics 4
A patient with a penicillin allergy requires GBS prophylaxis in labor.
Which antibiotic is the recommended first alternative?