A number of factors influence drug transfer into breastmilk. Which of the following is INCORRECT?

Correct Answer: B

Rationale: B is incorrect because larger breast size does not lead to greater protein binding. The size of the breast does not affect the protein binding capacity of breastmilk. Protein binding is influenced by the drug's chemical properties and the composition of breastmilk, not by the size of the breast. A is correct because the molecular size of the drug can affect its transfer into breastmilk. Smaller molecules are more likely to pass through the mammary gland into breastmilk, while larger molecules may be excluded. C is correct because the pH of breast milk is indeed slightly more acidic than maternal plasma. This difference in pH can affect the ionization of drugs and their ability to transfer into breastmilk. D is correct because the lipophilicity of the drug plays a significant role in its transfer into breastmilk. Lipophilic drugs are more likely to pass through the cell membranes of the mammary gland and into breastmilk, while hydrophilic drugs may be excluded. In summary, B is incorrect because breast size does not influence protein binding in breastmilk. A, C, and D are correct because the molecular size, pH, and lipophilicity of the drug are all important factors that can influence drug transfer into breastmilk.

Correct Answer: A

Rationale: Ginger is the correct answer because it has traditionally been used as an antiemetic for nausea and vomiting, especially during pregnancy. Ginger contains active compounds such as gingerol and shogaol that have been shown to help reduce nausea and vomiting by acting on the gastrointestinal system. Studies have supported the effectiveness of ginger in alleviating pregnancy-related nausea. Garlic is not the correct answer as it is not commonly used as an antiemetic. While garlic has many health benefits, it is not typically used specifically for nausea and vomiting. Ginkgo biloba is also not the correct answer. Ginkgo biloba is often used for cognitive function and circulation but is not known for its antiemetic properties. In fact, ginkgo biloba has been associated with side effects such as nausea and gastrointestinal upset in some individuals. Green tea is not the correct answer either. While green tea is a popular beverage with many health benefits, it is not typically used as an antiemetic. In some cases, green tea may actually worsen nausea due to its caffeine content. In conclusion, ginger is the best choice among the options provided as it has a long history of use as an antiemetic agent, especially in cases of pregnancy-related nausea and vomiting.

Correct Answer: C

Rationale: Magnesium sulfate is commonly used in obstetrics to prevent seizures in women with preeclampsia or eclampsia, as well as to stop preterm labor. The desired outcome related to the administration of magnesium sulfate is to decrease blood pressure (Choice C). Magnesium sulfate has vasodilatory effects which help to lower blood pressure in women with preeclampsia or eclampsia, reducing the risk of complications such as stroke or organ damage. Choice A (Increased contractions) is incorrect because magnesium sulfate is actually used to stop preterm labor by relaxing the uterine muscles and preventing contractions. It is a tocolytic agent, not a uterotonic. Choice B (Respiratory rate above 18) is incorrect because magnesium sulfate can actually depress the respiratory system, leading to respiratory depression or even respiratory arrest in high doses. Therefore, it is important to monitor the respiratory rate closely when administering magnesium sulfate. Choice D (Increased uterine tone) is incorrect because, as mentioned earlier, magnesium sulfate is a tocolytic agent that relaxes the uterine muscles to prevent preterm labor. It does not increase uterine tone. In fact, it is used to delay delivery to allow for the administration of corticosteroids to improve fetal lung maturity.

Correct Answer: B

Rationale: Hypermagnesemia is an electrolyte imbalance characterized by high levels of magnesium in the blood. In this scenario, the woman in labor is showing signs of hypermagnesemia due to the intravenous administration of magnesium sulfate. The first step in managing hypermagnesemia is to discontinue the source of excess magnesium, which in this case is the magnesium sulfate infusion. Calcium gluconate is the correct choice for the nurse to anticipate administering in this situation. Calcium gluconate is a calcium supplement that can help counteract the effects of hypermagnesemia. Calcium and magnesium have an inverse relationship in the body, so administering calcium can help lower magnesium levels and alleviate symptoms of hypermagnesemia. Metoprolol (Lopressor) is a beta-blocker used to treat high blood pressure and heart conditions. It is not indicated for the treatment of hypermagnesemia and would not address the underlying cause of the woman's symptoms. Potassium chloride is a supplement used to treat or prevent low potassium levels in the blood. It is unrelated to the treatment of hypermagnesemia and would not be appropriate in this situation. Furosemide (Lasix) is a loop diuretic used to treat fluid retention and high blood pressure. While diuretics can help eliminate excess magnesium in the body, they are not the first-line treatment for hypermagnesemia. Calcium gluconate is the more appropriate choice in this scenario to quickly counteract the effects of excess magnesium and alleviate symptoms.

Correct Answer: D

Rationale: Terbutaline sulfate (Brethine) is a beta-adrenergic agent that inhibits uterine contractions by reducing intracellular calcium levels. Adverse effects may include hyperkalemia, hyperglycemia, cardiac dysrhythmias, hypotension, and pulmonary edema. Women commonly experience hand tremors, palpitations, and shortness of breath with chest tightness.