Test Bank Pharmacology for the Primary Care Provider- 4th Edition- Edmunds Mayhew

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Test Bank Pharmacology for the Primary Care
Provider- 4th Edition- Edmunds Mayhew
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Chapter 06: Special Populations: Pregnant and Nursing Women
Test Bank
MULTIPLE CHOICE
1. A woman is in the 36th week of pregnancy. The nurse practitioner (NP) providing
prenatal care learns that the woman has a history of two previous urinary tract
infections during this pregnancy. A dipstick urinalysis in the office today is
negative for leukocyte esterase and nitrites. The NP should:
prescribe a low-dose sulfonamide antibiotic for urinary tract infection
a.
prophylaxis.
order nitrofurantoin daily to minimize the patient’s risk of urinary tract
b.
infection late in her pregnancy.
encourage the patient to increase daily water intake and to wear only cotton
underwear.
order a voiding cystourethrogram to rule out structural anomalies that may
d.
cause urinary tract infection.
c.
ANS: C
For women at risk for recurrent urinary tract infection while pregnant, prevention and
treatment begin with nonpharmacologic therapy: forcing fluids and wearing cotton
underpants. Sulfonamide antibiotics and nitrofurantoin are used for documented urinary
tract infection during pregnancy, but not after the 36th week of gestation. A voiding
cystourethrogram is not indicated and would expose the fetus to radiation.
DIF:
Cognitive Level: Applying (Application)
REF: 77 – 78
2. A woman tells a primary care NP that she is considering getting pregnant. During
a.
b.
c.
d.
a health history, the NP learns that the patient has seasonal allergies, asthma,
and epilepsy, all of which are well controlled with a second-generation
antihistamine daily, an inhaled steroid daily with albuterol as needed, and an
antiepileptic medication daily. The NP should counsel this patient to:
take her asthma medications only when she is having an acute
exacerbation.
avoid using antihistamine medications during her first trimester of
pregnancy.
discontinue her seizure medications at least 6 months before becoming
pregnant.
use only oral corticosteroids and not inhaled steroids while pregnant for
improved asthma control.
ANS: B
Optimal treatment of asthma during pregnancy includes treatment of comorbid allergic
rhinitis, which can trigger symptoms. Antihistamines are recommended after the first
trimester, if possible. Asthma medications should be continued during pregnancy
because poorly controlled asthma can be detrimental to the fetus; she should continue
using her daily inhaled corticosteroid. Although discontinuing seizure medications is
optimal, this must be done in conjunction with this woman’s neurologist because
management of epilepsy during pregnancy is beyond the scope of the primary care
provider. Oral corticosteroids have greater systemic side effects and greater effects on
the fetus and should be used only as necessary.
DIF:
Cognitive Level: Applying (Application)
REF: 78 – 79
3. A woman has just learned she is pregnant and is in her 10th gestational week.
a.
b.
c.
d.
The woman reports that she takes valproic sodium (Depakote) for a seizure
disorder and has been seizure-free for several years. The NP should:
prescribe folic acid supplements.
change her antiepileptic drug to lamotrigine (Lamictal).
order prophylactic vitamin K to be given in the second trimester.
recommend that she discontinue taking the valproic sodium by 12 weeks.
ANS: A
Maternal folic acid deficiency is induced by anticonvulsants, especially valproic acid, so
folic acid supplements must be given. Although antiepileptic drugs can have
consequences for the developing fetus, once a woman is pregnant, the benefit-risk ratio
favors continued use of the woman’s current antiepileptic medication, so she should not
discontinue the medication or change to lamotrigine. Vitamin K is recommended
beginning at 36 weeks of gestation and for the newborn at birth to counter the possibility
of hemorrhagic disease of the newborn.
DIF:
Cognitive Level: Applying (Application)
REF: 79
4. A woman who is pregnant develops gestational diabetes. The NP’s initial action
is to:
a. prescribe an oral antidiabetic agent.
b. give her information about diet and exercise.
c. begin treating her with daily insulin injections.
d. reassure her that her glucose levels will return to normal after pregnancy.
ANS: B
Patients with gestational diabetes should be treated with diet and exercise, with insulin
added as needed for poor control. There is insufficient evidence to support the use of
oral antidiabetic agents during pregnancy, and some of these are pregnancy category
D. Insulin injections may be used but are not the initial intervention. Although glucose
levels will return to prepregnancy values in the postpartum period, the NP must initiate
therapy.
DIF:
Cognitive Level: Applying (Application)
REF: 79 – 80
5. A woman who takes an angiotensin converting enzyme inhibitor for hypertension
a.
b.
c.
d.
tells her primary care NP that she is trying to get pregnant. The NP should:
consider replacing her angiotensin converting enzyme inhibitor with
methyldopa.
lower her angiotensin converting enzyme inhibitor dose during the first
trimester.
counsel her to increase her antihypertensive medications during pregnancy.
add an angiotensin receptor blocker (ARB) during the first trimester of her
pregnancy.
ANS: A
Angiotensin converting enzyme inhibitors, ARBs, and statins are contraindicated during
the first trimester of pregnancy and should be discontinued before conception and
replaced by safer alternatives, such as methyldopa. The use of antihypertensives during
pregnancy remains controversial; increasing the dose is not indicated.
DIF:
Cognitive Level: Applying (Application)
REF: 80
6. A woman who is pregnant tells an NP that she has been taking sertraline for
a.
b.
c.
d.
depression for several years but is worried about the effects of this drug on her
fetus. The NP will consult with this patient’s psychiatrist and will recommend that
she:
stop taking the sertraline now.
continue taking the antidepressant.
change to a monoamine oxidase inhibitor (MAOI).
discontinue the sertraline a week before delivery.
ANS: B
Many women are taking medication for depression before becoming pregnant. Abrupt
discontinuation is not recommended, and many clinicians suggest that women at high
risk for serious depression during pregnancy might best be served by continuing
medication throughout pregnancy. MAOIs may limit fetal growth and are generally
discouraged during pregnancy. It is not necessary to discontinue the sertraline just
before delivery.
DIF:
Cognitive Level: Applying (Application)
REF: 80
7. A woman is 4 weeks pregnant. The primary care NP sees her for her first
a.
b.
c.
d.
prenatal visit and obtains a rubella titer, which is negative. The woman tells the
NP that she drinks 2 cups of coffee and smokes 3 to 5 cigarettes each day. She
denies alcohol use. The NP should:
administer rubella vaccine.
provide smoking cessation information.
counsel her to avoid caffeine while pregnant.
reassure her that her habits are not likely to cause harm.
ANS: B
Each cigarette smoked decreases maternal blood pressure for up to 15 minutes and
decreases uteroplacental perfusion. The NP should encourage the woman to quit
smoking. Rubella vaccine should be given after the baby is delivered because rubella
vaccine is a live virus, with severe teratogenic effects. There is no conclusive evidence
that women who are pregnant should avoid caffeine completely. Her habits, although
not severe, are not harmless.
DIF:
Cognitive Level: Applying (Application)
REF: 82 – 83
8. A woman who is breastfeeding her infant asks the primary care NP what she can
use for headaches while she is nursing. The NP tells her:
a. most medications enter breast milk and are not safe.
b. most over-the-counter medications are safe for the breastfed infant.
she may need to interrupt breastfeeding when taking headache
c.
medications.
she should consider weaning her infant to formula if her headaches are
d.
frequent.
ANS: B
Most over-the-counter medications are considered safe for the breastfed infant and do
not necessitate a disruption of breastfeeding, even though most medications cross
easily into breast milk. Any interruption of breastfeeding carries a risk of premature
weaning and so is indicated only when the mother must take medications known to
cause serious harm to the baby. It is not recommended that she wean her infant to
formula when she needs medications for her headaches.
DIF:
Cognitive Level: Applying (Application)
REF: 85
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