A woman who is 7 months pregnant is waking up at night with gastroesophageal reflux. Which of the following medications is most highly recommended?

Correct Answer: C

Rationale: In early pregnancy, gastroesophageal reflux is a common issue due to hormonal changes and the growing uterus putting pressure on the stomach. The most highly recommended medication for this symptom is Ranitidine (Zantac). Ranitidine is a histamine-2 blocker that reduces stomach acid production, providing relief from reflux without adverse effects on the fetus. Option A, Terbutaline (Brethine), is a bronchodilator used to relax the uterus in preterm labor, not indicated for reflux. Option B, Diphenoxylate (Lomotil), is an antidiarrheal medication, not effective for reflux. Option D, Chlorothiazide (Diuril), is a diuretic used to treat high blood pressure and edema, not relevant for gastroesophageal reflux. Educationally, understanding the rationale behind choosing the correct medication reinforces the importance of considering the physiological changes in pregnancy and selecting safe and effective treatments. It also highlights the need for healthcare providers to have a comprehensive knowledge of medications commonly used in pregnancy to provide optimal care for pregnant individuals.

Correct Answer: A

Rationale: In this scenario, the correct answer is A) Four hours must elapse after the last dose of misoprostol. This is crucial because misoprostol can cause uterine hyperstimulation, which may lead to fetal distress. By waiting for four hours after the last dose, the risk of excessive uterine contractions is minimized before starting oxytocin to induce labor. Option B) The woman must have a type and cross-match performed is incorrect because this is not a necessary step before administering oxytocin for labor induction. Type and cross-match are typically done for blood transfusions to ensure compatibility, not for initiating oxytocin. Option C) The woman must receive a bolus of 500-mL normal saline is incorrect as well. While hydration is important during labor, it is not a prerequisite for switching from misoprostol to oxytocin. Option D) The woman must have her electrolytes measured is also incorrect in this context. Monitoring electrolytes is important in labor, especially with oxytocin use, but it is not a prerequisite before switching medications in this situation. Educationally, understanding the pharmacology and potential side effects of medications used in labor induction is crucial for healthcare providers to ensure safe and effective care for both the mother and the baby. Proper sequencing of interventions is essential to prevent complications and promote positive outcomes in obstetric care.

Correct Answer: C

Rationale: Ovulation occurs 5 to 10 days after the course of clomiphene treatment has been completed. Prior to beginning the drug regimen, the nurse instructs the woman about taking her basal temperature 5 to 10 days following administration. An incremental rise in temperature is an indication of ovulation. There is no specific contraindication against alcohol, and neurological adverse effects are not expected.

Correct Answer: D

Rationale: The correct answer is D) Most medications are contraindicated while a woman is breast-feeding because it is essential to consider the impact of medications on the nursing infant. While some medications are safe to use during breastfeeding, many can pass into breast milk and potentially harm the baby. Therefore, it is crucial for breastfeeding mothers to consult with healthcare providers before taking any medications to ensure the safety of their infants. Option A is incorrect because while few medications are explicitly contraindicated, many do carry risks and need to be carefully evaluated before use during breastfeeding. Option B is incorrect as herbs can also have potential risks and interactions with breastfeeding. Option C is incorrect as resuming a prepregnancy medication regimen may not always be safe for the nursing baby without proper evaluation. In an educational context, understanding the principles of medication safety during breastfeeding is crucial for healthcare providers and new mothers. It highlights the importance of individualized assessment and guidance to ensure the well-being of both the mother and the infant. Healthcare professionals should provide evidence-based information to support informed decision-making regarding medication use while breastfeeding.

Correct Answer: D

Rationale: Progesterone is a crucial hormone during pregnancy, and option D, which states that progesterone maintains the endometrium around the fetus, is the correct statement. Progesterone plays a key role in supporting the early stages of pregnancy by maintaining the thickened endometrial lining, which provides a nourishing environment for the developing fetus. Option A is incorrect because progesterone does not produce human chorionic gonadotropin (hCG); rather, hCG is produced by the placenta. Option B is also incorrect as duct formation in the breast is primarily stimulated by estrogen, not progesterone. Option C is inaccurate as progesterone actually helps to maintain the endometrial wall, rather than promoting its sloughing. In an educational context, understanding the functions of hormones like progesterone in early pregnancy is essential for healthcare providers, nurses, and students specializing in obstetrics and gynecology. This knowledge is crucial for providing optimal care to pregnant individuals and recognizing and managing complications that may arise during this critical period.