A pregnant patient asks the nurse about the safe use of ...

[Collmarie]

A pregnant patient asks the nurse about the safe use of medications during the third trimester. What will the nurse tell her about drugs taken at this stage?
 
  a. They may need to be given in higher doses if they undergo renal clearance.
  b. They require lower doses if they are me-tabolized by the liver.
  c. They are less likely to cross the placenta and affect the fetus.
  d. They are more likely to cause anatomical defects if they are teratogenic.

Question 2

A nurse preparing to administer morning medications notes that a patient with a history of hypertension has been prescribed spironolactone Aldactone.
 
  The nurse assesses the patient and notes dyspnea, bilateral crackles, and pitting edema in both feet. Which intervention is appropri-ate? a. Administer the medications as ordered.
  b. Ask the patient about the use of salt subs-titutes.
  c. Contact the provider to request an order for serum electrolytes.
  d. Request an order for furosemide Lasix.

[ky860224]

Answer to Question 1

A
In the third trimester, drugs excreted by the kidneys may have to be increased, because renal blood flow is doubled, the glomerular filtration rate is increased, and drug clearance is accele-rated. Hepatic metabolism increases, meaning that drugs metabolized by the liver must be in-creased. All drugs can cross the placenta. Anatomic defects are more likely to occur in the em-bryonic period, which is in weeks 3 through 8 in the first trimester.

Answer to Question 2

D
Spironolactone takes up to 48 hours for its effects to develop, so it should not be used when the patient needs immediate diuresis. This patient has shortness of breath, crackles, and edema and needs a short-acting diuretic, such as furosemide. Asking the patient about the use of salt substi-tutes is not indicated. The patient does not need assessment of serum electrolytes.

[Collmarie]

TYSM

[Joy Chen]

Excellent