A mother has just given birth to a baby boy. A nurse notes that ...

[piesebel]

A mother has just given birth to a baby boy. A nurse notes that the infant has a cleft palate and low-set, malformed ears. The mother is upset and wants to know what is wrong with her baby.
 
  The nurse's most appropriate answer would be
  a. Do you recall any medications that you took during the second trimester of your pregnancy?
  b. Please don't be concerned, a cleft palate is not that uncommon and can be fixed.
  c. It is important that I take a medication history from you concerning medications that you took, if any, during your first trimester.
  d. Did you take any medications or herbal products during your last trimester?

Question 2

A nurse is making rounds and performing physical assessments on each of the assigned patients. Which patient would the nurse most likely anticipate developing tachyphylaxis, so that she assesses for it specifically?
 
  a. A patient who has been using opioids for pain relief
  b. A patient who has been using opioids for recreational purposes
  c. A patient who has been taking large doses of insulin for a long time
  d. A patient who has been wearing a nitroglycerin patch for 24 hours

[l.stuut]

Answer to Question 1

ANS: C
A cleft palate, low-set, malformed ears, and deafness typically are the result of teratogens consumed during the first trimester; therefore taking an accurate and complete medication history is important.
Telling the patient not to worry is condescending and does not validate her feelings.
A cleft palate would not develop during the second trimester, because the mouth and gut are formed at 7 to 12 weeks' gestation.
A cleft palate would not develop during the third trimester, because the mouth and gut are formed at 7 to 12 weeks' gestation.

Answer to Question 2

ANS: D
Tachyphylaxis is a form of tolerance that can be defined as a reduction in drug responsiveness brought on by repeated dosing over a short time. When nitroglycerin is administered by means of a transdermal patch, the effects are lost in less than 24 hours if the patch is left in place around the clock. This is why the nitroglycerin patch typically is ordered every 8 to 12 hours on and 8 to 12 hours off, to keep the body from building up tolerance (i.e., tachyphylaxis).
Opioids, whether used for pain relief or recreational purposes, do not cause tachyphylaxis.
Insulin, even when taken in large doses for extended periods, does not cause tachyphylaxis.

[piesebel]

Thanks for the timely response, appreciate it

[softEldritch]

Excellent