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Quantum Units Education®

Treating Pregnant and Parenting Women with Opioid Use Disorder

Part A: Introduction

1. The rate of neonatal abstinence syndrome:

A. Is higher in rural regions

B. Is higher in urban regions

C. Is uniform across the nation

D. Is unknown


2. Which of the following is a barrier that can prevent women from receiving essential prenatal care or treatment for their OUD until they are close to delivery or in labor?

A. Legal consequences that sanction pregnant women with OUD.

B. The shame associated with OUD during pregnancy and motherhood.

C. Misinformation among healthcare professionals and systems that result in reluctance to provide care for women during pregnancy.

D. All of the above.


3. Without treatment, pregnant women with OUD face increased risks of:

A. Preterm delivery

B. Low infant birth weight

C. Transmitting HIV to their infant

D. All of the above


Prenatal Screenings and Assessments

4. Pregnant women with OUD should receive counseling and education on all of the following, except:

A. The medical and social consequences of pharmacotherapy for OUD.

B. The universal approach to assessing the consequences of legitimate pharmacotherapy for OUD or other substance use during pregnancy.

C. The continued use of legal and illicit substances while pregnant.

D. Withdrawal from opioids while pregnant with inherent risks to mother and fetus of relapse.


5. The World Health Organization recommends that healthcare professions ask all pregnant women about their use of alcohol and other substance as early as possible in the pregnancy and at every follow-up visit.

A. True

B. False


6. Healthcare professionals need to determine whether any of their pregnant patients are currently taking, or have recently taken:

A. Methadone

B. Buprenorphine

C. Long-acting opioids

D. All of the above


7. A toxicology screen should not be obtained if substance use is self-reported.

A. True

B. False


8. For any pregnancy, the healthcare professional’s priority is to:

A. Ensure the well-being of the woman and fetus.

B. Alert local law enforcement to illicit drug use.

C. Alert Child Protective Services to the harm being caused to her unborn child and possible other children.

D. Involve a mental health professional to get the woman to stop her substance abuse while pregnant.


9. The pregnant and postpartum woman with OUD should be encouraged to keep trying to reach the goal of ending substance use through all of the following, except:

A. Pharmacotherapy

B. Behavioral interventions

C. Abstinence

D. All of the above should be used to discontinue substance use


10. Immediate and simultaneous discontinuation of all substances may not be feasible or safe, particularly during pregnancy because of the additional risk to the developing fetus, which may also be going through withdrawal unmonitored.

A. True

B. False


11. Screening for HIV/AIDS and hepatitis B and C should be standard at any initial assessment, regardless of the stage of pregnancy.

A. True

B. False


12. If a patient is new to pharmacotherapy for OUD or wishes to resume pharmacotherapy for OUD and is HIV-positive, methadone should be considered as the first-line treatment.

A. True

B. False


Initiating Pharmacotherapy for Opioid Use Disorder

13. A woman receiving either buprenorphine or methadone should be informed that the benefits of pharmacotherapy for OUD during pregnancy outweigh the risks of untreated OUD.

A. True

B. False


14. All patients receiving prenatal or medical treatment must give their informed consent to be treated and indicate that they understand:

A. The treatment that is being provided.

B. The risks and benefits of the treatment and the risk of not treating the OUD.

C. What to do in an emergency.

D. All of the above.


15. Avoidance of NAS should be the deciding factor in the initiation and dose of pharmacotherapy for OUD during pregnancy, as the dose of medication impacts the risk and severity of NAS.

A. True

B. False


16. Individuals who select _____ for pharmacotherapy need to be aware of the potential for spontaneous or precipitated withdrawal during pharmacotherapy induction and must be exhibiting clinical withdrawal symptoms before administration of the first dose.

A. Methadone

B. Buprenorphine

C. Both (A) and (B)

D. None of the above


17. Currently, research indicates no known risk of increased birth defects associated with the use of:

A. Methadone

B. Buprenorphine

C. Both (A) and (B)

D. None of the above


18. Studies show which of the following to have higher retention in treatment?

A. Methadone

B. Buprenorphine

C. Both (A) and (B) have equal retention

D. None of the above


Changing Pharmacotherapy During Pregnancy

19. Cravings occur only when an OUD is not well managed, therefore, a pregnant women should be switched to a different opioid agonist based on experiencing cravings.

A. True

B. False


20. Pregnant women with OUD, with or without a history of pharmacotherapy for OUD, should be advised that medically supervised withdrawal from opioids is associated with high rates of return to substance use and is not the recommended course of treatment.

A. True

B. False


21. The dose of methadone and buprenorphine has been linked to:

A. Peak NAS score

B. Total amount of infant treatment medication

C. Length of neonatal hospital stay

D. None of the above


22. Which of the following requires several days of abstinence from one pharmacotherapy before initiation of another pharmacotherapy?

A. Changing from buprenorphine to methadone

B. Changing from methadone to buprenorphine

C. Both (A) and (B)

D. None of the above


Managing Pharmacotherapy Over the Course of Pregnancy

23. Which of the following may need to be adjusted during pregnancy to prevent withdrawal symptoms and return to substance use?

A. The dose of pharmacotherapy

B. The behavioral interventions provided

C. Both (A) and (B)

D. None of the above


24. Which of the following is associated with the degree of NAS the baby may experience?

A. The amount or dose of the medication used to treat her OUD

B. Tobacco use

C. Both (A) and (B)

D. None of the above


25. Because the rate of methadone clearance is increased when _____ levels are elevated, doses of methadone typically need adjusting upward, particularly in the third trimester.

A. Progesterone

B. Human chorionic gonadotropin

C. Oxytocin

D. Estradiol


26. What is involved in “recovery”?

A. Individuals improve their health and wellness.

B. Individuals live self-directed lives.

C. Individuals strive to reach their full potential.

D. All of the above.


Pregnant Women With Opioid Use Disorder and Comorbid Behavioral Health Disorders

27. Research has found that the majority of women entering treatment for OUD:

A. Have a history of sexual assault, trauma, or domestic violent.

B. Come from homes where their caregivers used drugs.

C. Both (A) and/or (B).

D. None of the above.


28. All of the following problematic pharmacokinetic drug interactions may occur when psychotropic medications are combined with buprenorphine, except for:

A. Respiratory depression when combined with benzodiazepines.

B. Prolonged QTc when combined with SSRIs or tricycling antidepressants.

C. Serotonin syndrome when combined with monoamine oxidase inhibitors.

D. All of the above may occur when combined with buprenorphine.


29. Infants whose mothers received _____ during pregnancy are at risk for manifesting clinical signs of drug toxicity including NAS during their first week of life.

A. SSRIs

B. SNRIs

C. MAOIs

D. All of the above


30. Which of the following is associated with premature birth?

A. Depression during pregnancy

B. Continuous use of SSRIs during pregnancy

C. Both (A) and (B)

D. None of the above


31. Expectant mothers receiving treatment with buprenorphine or methadone who use benzodiazepines should work with a psychiatrist to stabilize their anxiety and reduce their use of benzodiazepines if possible, with a gradual taper of a long-acting benzodiazepine toward the goal of being benzodiazepine free at delivery.

A. True

B. False


32. The dose of individual psychiatric medications should be evaluated for possible adjustment in the _____ trimester.

A. First

B. Second

C. Third

D. All of the above


Addressing Polysubstance Use During Pregnancy

33. A pregnant woman on pharmacotherapy for OUD who has concurrent other substance use or who returns to use of one or more other substances should receive:

A. Behavioral interventions targeting the use of the substance(s).

B. Pharmacotherapy, if available and safe in pregnancy for the substance(s) she is using.

C. Both (A) and (B).

D. None of the above.


34. Returning to substance use should be viewed as:

A. A setback or failure.

B. An indication of the need to reassess the patient and adjust the treatment plan.

C. Both (A) and (B).

D. None of the above.


35. The risk of return to substance use is highest in the first _____ after stabilization is achieved.

A. 6 to 12 months

B. 2 to 6 months

C. 6 to 12 weeks

D. 2 to 6 weeks


36. A return to use of depressant drugs is highly concerning given the risk for respiratory depression when combined with opioid agonist therapy.

A. True

B. False


37. An alcohol use cessation program is one of the most important therapies to begin when a woman enters OUD treatment.

A. True

B. False


38. Alcohol and benzodiazepines may worsen the symptoms of NAS.

A. True

B. False


Planning Prior to Labor and Delivery

39. Which of the following increases the risk of developing a substance use disorder in life?

A. Carrying a genetic risk for substance use disorder.

B. Experiencing NAS as an infant.

C. Both (A) and (B).

D. None of the above.


40. Infant withdrawal usually begins within a few minutes after the baby is born.

A. True

B. False


41. If an infant has not experienced withdrawal within a few days after being born, it will not experience it.

A. True

B. False


42. Which infant-related variable can affect the infant’s NAS course?

A. Genetics

B. Gender

C. Gestational age

D. All of the above


43. The practice of minimizing or even reducing maternal opioid agonist medication to protect the fetus is unnecessary and should be avoided.

A. True

B. False


44. When appropriate, any amount of breastfeeding, however brief, can:

A. Decrease NAS severity.

B. Reduce the infant’s need for pharmacological treatment.

C. Decrease the length of pharmacological therapy and hospitalization.

D. All of the above.


Peripartum Pain Relief

45. When a woman is already using pharmacotherapy for OUD or has not started therapy and is misusing opioids, her option for pain control should be:

A. Epidural / spinal anesthesia

B. Short-acting opioid analgesics

C. Both (A) and (B)

D. None of the above


46. Which of the following should not be administered to a pregnant woman with OUD, whether she is on pharmacotherapy for OUD or not, as it can precipitate acute opioid withdrawal?

A. Butorphanol

B. Nalbuphine

C. Pentazocine

D. All of the above


47. Pregnant women on pharmacotherapy need to be transitioned from their maintenance medication before a planned cesarean section.

A. True

B. False


Screening and Assessment for Neonatal Abstinence Syndrome

48. Toxicology screening of _____ does not require informed consent.

A. The mother

B. The infant

C. Both (A) and (B)

D. None of the above


49. An opioid-exposed newborn requires a minimum of _____ in the hospital for NAS scoring.

A. 120 hours

B. 96 hours

C. 72 hours

D. 48 hours


50. Hospitals should use a standardized protocol for:

A. Screening for substance exposure.

B. Monitoring NAS in an opioid-exposed infant.

C. Treating NAS in an opioid-exposed infant.

D. All of the above.


51. The collection of which of the following is exempt from maternal consent procedures?

A. Amniotic fluid and placental tissues

B. Cord blood

C. Meconium

D. All of the above


Management of Neonatal Abstinence Syndrome

52. Infants with mild NAS should be managed with:

A. Liquid oral morphine

B. Sublingual buprenorphine

C. Tincture of opium

D. Phenobarbital


53. Regardless of medication type, infants managed with a standard protocol require a shorter duration of NAS medication treatment and a shorter hospital stay.

A. True

B. False


54. Nonpharmacologic care of the substance-exposed mother-infant dyad consists of:

A. A thorough understanding of the newborn’s functioning with the goals of implementing comforting techniques and environmental modifications and promoting the infant’s self-regulation and interactive capabilities.

B. A thorough understanding of the mother’s strengths and challenges to promote her self-regulation, confidence as a parent, and ability to respond contingently to and communicate with her infant.

C. Attention to the dyadic communication patterns and behaviors and the environment that may need modifications to support the infant’s physiologic organization and regulation and to encourage the mother to respond sensitively to the infant’s needs.

D. All of the above.


55. Which of the following has been consistently associated with a reduced need for medication to treat NAS and a shortened neonatal hospital stay?

A. Extended skin-to-skin contact with the mother

B. Swaddling

C. Rooming-in

D. Supine positioning


Breastfeeding Considerations for Infants at Risk for Neonatal Abstinence Syndrome

56. Upon delivery, women who are stable on buprenorphine, buprenorphine / naloxone combination, or methadone should be advised to breastfeed, if appropriate.

A. True

B. False


57. Buprenorphine and methadone levels in breast milk are very low when the mother is on pharmacotherapy and pose little risk to infants.

A. True

B. False


58. The benefit that the infants with NAS derive from breastfeeding is attributed to:

A. The act of breastfeeding

B. The amount of maternal opioid agonist secreted into the breast milk

C. Both (A) and (B)

D. None of the above


Infant Discharge Planning

59. An infant treated for NAS who _____ should be promptly evaluated by a healthcare professional.

A. Has trouble eating or sleeping

B. Is crying more than expected

C. Has loose stools after discharge

D. Any of the above


60. Infants should only be swaddled at home if the caregivers have been given training in swaddling.

A. True

B. False


61. The most promising prevention interventions _____ across multiple domains.

A. Provide reduction of risks

B. Boosts protective factors

C. Both (A) and (B)

D. None of the above


Early Intervention Strategies and Developmental Assessments

62. Infants born to mothers who receive methadone or buprenorphine during pregnancy are found as toddlers to have more problems with certain developmental tasks than those from a normative sample of children of mothers without SUD, after controlling for confounding factors.

A. True

B. False


Adjusting Pharmacotherapy Dose Postpartum

63. In the immediate postpartum period, complaints of _____ should prompt evaluation of the new mother’s dose of agonist therapy.

A. Drowsiness

B. Somnolence

C. Both (A) and (B)

D. None of the above


64. Because of the variability in dosing amounts before delivery, healthcare professionals are advised to use signs of _____ to guide their recommendations on tapering the postpartum dose for new mothers using either methadone or buprenorphine.

A. Respiratory depression

B. Somnolence

C. Cravings

D. Withdrawal symptoms


65. The longer the patient continues on OUD pharmacotherapy, the lower her risk of return to substance use when she eventually chooses to taper.

A. True

B. False


Maternal Discharge Planning

66. The discharge plan of safe care should address:

A. Potential maternal comorbid medical or mental disorders.

B. Any existing maternal comorbid medical or psychiatric condition and recognize that the physiologic change after delivery, stress, and sleep deprivation the new mother experiences may exacerbate these conditions or trigger a return to some form of substance use.

C. Strategies for the new mother to get immediate and nonjudgmental assistance if she feels she is or may become unstable.

D. All of the above.


67. Gradual tapering is not needed for pharmacotherapy with methadone or buprenorphine, as there is no risk of withdrawal.

A. True

B. False


68. Discontinuation of pharmacotherapy should, at the very least, be delayed until after the infant is consistently sleeping through the night and has completed breastfeeding.

A. True

B. False


Maternal Return to Substance Use

69. Behavioral health services often focus on preventing a return to substance use, such as through teaching new mothers how to manage triggers and connecting these clients to peer recovery support groups and programs that help new parents.

A. True

B. False


70. The exception to the privacy rule affecting behavioral healthcare is:

A. If it appears the woman may harm herself or others.

B. If the woman has been ordered into treatment by the courts.

C. Both (A) and (B).

D. None of the above.


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