Maternal HESI practice

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Which birth control agent requires administration once every three months?

Intramuscular Progestin

Which teratogenic effect is seen due to lithium?

Ebstein anomaly

Which drug is known as an abortion pill?


What is the action of oxytocin in a pregnant client at term?

Induction of labor

Which category of drugs carries fetal risk in humans?


Which drug taken by a pregnant woman shows a delayed teratogenic effect in the offspring, making the effect difficult to identify?


A multipara is admitted to the birthing room in active labor. Her temperature is 98° F (36.7° C); pulse, 70 beats/min; respirations, 18 breaths/min; and blood pressure, 126/76 mm Hg. A vaginal examination reveals a cervix that is 90% effaced and 7 cm dilated with the vertex presenting at 2+ station. The client is complaining of pain and asks for medication. Which medication may cause respiratory depression in the newborn?


A client making her first visit to the prenatal clinic asks which immunization can be administered safely to a pregnant woman. What should the nurse tell her?


A 31-year-old client is seeking contraceptive information. Before responding to the client’s questions about contraceptives, the nurse obtains a health history. What factor in the client’s history indicates to the nurse that oral contraceptives are contraindicated?

BP of 162/110

During which period of pregnancy do teratogens act in an "all-or-nothing" fashion?

Presomite period

A client is admitted for induction of labor. An intravenous infusion of oxytocin is started. When the client’s contractions begin they are 1.5 to 2 minutes in duration. While the nurse is in the room, one contraction lasts 3 minutes. What should the nurse do first?

Turn off the oxytocin infusion

Which drug is contraindicated during pregnancy but can be safely used by lactating mothers?


Which oxytocic drug may help to control uterine bleeding post-delivery and promote milk ejection?


A client was treated with methotrexate for cancer during the 6th month of her pregnancy. Which teratogenic effect may be seen in the child?

Mental retardation

A client is admitted to the birthing unit in active labor. Cervical dilation has progressed from 2 to 3 cm over the previous 8 hours. The primary healthcare provider determines that the client has hypotonic dystocia, and an infusion of oxytocin is prescribed to augment her contractions. What is the most important nursing action at this time?

Monitoring the duration and intensity of the contractions

Which pregnancy safety category shows a proven risk of fetal harm, but potential benefits of use during pregnancy may be acceptable despite its risks?

Category C

A laboring client who is positive for group B Streptococcus (GBS) is given an initial dose of 2 g of ampicillin at 9 AM. According to established guidelines for intrapartum management of this client, what should the next dose be?

1 g given at 1 PM

Which situation is an indication for an oxytocin infusion?

Induction of labor at full-term

Which statements relate to preterm labor? Select all that apply.

1. The treatment for preterm labor includes bed rest and hydration. 2. Preterm labor before the 20th week is indicative of a nonviable fetus.

Which drug is a teratogen that may cause masculinization of a female fetus?


Which hormone can cause ovulation and promote lactation?


What may happen when clomiphene is co-administered with methyldopa to promote ovulation?

Impaired Infertility

Which drug is safe to administer to a lactating woman but may cause teratogenic effects when administered to pregnant clients?


What is the most widely used off-label drug for cervical ripening and the enhancement of uterine muscle tone?


A primigravida has just given birth. The nurse is aware that the client has type AB Rh-negative blood. Her newborn’s blood type is B positive. What should the plan of care include?

Obtaining a prescription to administer Rho(D) immune globulin to the mother

A drug is administered to a client in her third trimester of pregnancy. Which statement regarding the drug administration is correct?

Drug should be increased for the pregnant client.

Which risk is associated with estrogen therapy in a client who smokes?

Thromboembolic disorders

During a prenatal visit a nurse explains to a client who is Rh negative when Rho(D) immune globulin will be administered to her. When is the best time to administer Rho(D) immune globulin?

Within 72 hours of birth if the infant is Rh positive

A nurse is counseling a pregnant client with iron-deficiency anemia about when and how to take supplemental iron. What time of day is iron absorption most efficient?

Before Breakfast

Which ovulation stimulant is derived from the urine of postmenopausal women?


Which medication is indicated for evacuation in case of a miscarriage?


Which type of drug readily enters the breast milk?

Lipid soluble

A pregnant client at 30 weeks’ gestation begins to experience contractions every 5 to 7 minutes. She is admitted with a diagnosis of preterm labor. Although the client is being given tocolytic therapy, her cervix continues to dilate, and it is determined that a preterm birth is inevitable. Which medication does the nurse expect the primary healthcare provider to prescribe?


A nurse withholds methylergonovine maleate from a postpartum client. What clinical finding supports the withholding of the medication?


A breastfeeding mother requires treatment for depression. Which drug would be safe to use if the mother wishes to continue breastfeeding the newborn?


Which birth control agent requires administration once every three months?

Intramuscular progestin

A client at 32 weeks’ gestation is admitted in active labor. Her cervix is effaced and dilated 4 cm. Intramuscular betamethasone 12 mg is prescribed. What should the nurse tell the client about why the medication is being given?

Fetal lung maturity is accelerated

Which drug may cause Ebstein anomaly as a teratogenic effect and is also contraindicated in breast-feeding clients?


A client is receiving antibiotics and antifungal medications for the treatment of a recurring vaginal infection. What should the nurse encourage the client to do to compensate for the effect of these medications?

Eat yogurt with active cultures daily.

Which drug is known as an abortion pill?


A nurse has just finished reviewing how anesthesia will be used during a vaginal birth for a client with class I heart disease. What type of anesthesia does the client discuss that indicates to the nurse that the teaching was effective?


A newborn who is receiving drug therapy for an infection has developed jaundice. The newborn has poor sucking and extreme sleepiness. Which drug may be responsible for the newborn’s condition?


Which drug may cause formation of abnormally small eyes in the newborn if used during pregnancy?


A registered nurse teaches a nursing student about the physiologic changes that occur during pregnancy and their impact on drug disposition and dosing. Which statement of the nursing student indicates the need for further education?

The hepatic metabolism of a drug is decreased

During which period of pregnancy would functional disabilities in a fetus’s brain occur via fetal exposure to a teratogenic agent?


Which chemical may be responsible for Braxton Hicks contractions occurring during the final weeks of pregnancy?


A client in preterm labor is to receive a tocolytic medication, and bed rest is prescribed. Which position should the nurse suggest that the client maintain while on bed rest?


A client is taking a progesterone oral contraceptive (minipill). The nurse instructs the client to take one pill daily during which point in the monthly cycle?

The whole time

Oxytocin is given to induce uterine contractions when normal labor does not occur in the final weeks of gestation. Nifedipine and indomethacin are used to control preterm labor. Methylergonovine is used to control postpartum hemorrhage.

Which antihypertensive drug is contraindicated in lactating women?


A nurse is caring for a primigravida during labor. At 7 cm of dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression?


A newborn with a cleft lip and palate is born to a mother who has a history of epilepsy. Which drug might be responsible for this malformation?


Which drug is used to manage nonmetastatic gestational trophoblastic disease?


A client is prescribed dinoprostone for the termination of a pregnancy. What is the route of administration of the drug?


Which drug is used to induce spontaneous abortions?


The clinic nurse is planning care for a client found to have chlamydia. Which treatment should the nurse plan to implement?

Administration of 1 g of azithromycin orally in a single dose

Which cardiovascular adverse effect is associated with the use of clomiphene?


Which pregnancy safety category shows a proven risk of fetal harm, but potential benefits of use during pregnancy may be acceptable despite its risks?


A nurse is caring for a primigravida during labor. At 7 cm of dilation a prescribed pain medication is administered. Which medication requires monitoring of the newborn for the side effect of respiratory depression?


Which drug can be prescribed to a 30-week-pregnant woman to promote maturity of the lungs in the fetus?


Which adverse effects of fertility drugs are consequences of their extended action? Select all that apply.

Multiple pregnancies Ovarian overstimulation

Which statement regarding transdermal estradiol is true?

slowly absorbed from the skin

A woman questions the nurse about the effectiveness of oral contraceptives. What most important factor about the effectiveness of oral contraceptives should be included in the reply to this question?

User motivation

A nurse in the prenatal clinic is obtaining the health history of a 39-year-old primigravida. What question should the nurse ask to elicit information about exposure to diethylstilbestrol (DES)?

"Do you know if your mother took hormones during her pregnancy?

During labor a client who has been receiving epidural anesthesia has a sudden episode of severe nausea, and her skin becomes pale and clammy. What is the nurse’s immediate reaction?

Turning the patient on the side

After breast cancer is diagnosed, the client decides on a modified radical mastectomy followed by a combination therapy protocol that includes doxorubicin. What assessment finding does the nurse recognize as a toxic effect of this drug?

Cardiac dysrhythmias

A registered nurse teaches a nursing student about caring a client who is prescribed estradiol to treat low estrogen levels. Which statement of the nursing student indicates a need for additional learning?

"I should avoid covering the medication with clothing after it is dried."

Which gestational period is appropriate for the administration of corticosteroids during preterm labor?

24 to 34 weeks

A lactating woman receives treatment for a medical condition and is taking a prescription medication that cannot be withheld. What type of drugs can the client take to minimize the risk to the neonate? Select all that apply.

Drugs that are excluded from milk Drugs consumed immediately after breastfeeding Drugs that are the least likely to affect the neonate

Which criteria may prove that a drug is a teratogen? Select all that apply.

The drug may cause fetal malformations. The drug acts in the gestation period The drug-related malformations increase with an increase in the dose and exposure

Shortly after birth the nurse instills erythromycin ophthalmic ointment in the newborn’s eyes. The father asks why an antibiotic is needed. The nurse explains that it is routinely administered to prevent what type of infection?


A pregnant woman reports upper back pain and frequent and painful urination. Upon diagnosis, the client has a urinary tract infection and is treated with nitrofurantoin. Which teratogenic effect is likely to occur in the infant?

Cleft Palat

Which interventions are included in the nursing care for a client receiving magnesium sulfate for severe preeclampsia? Select all that apply.

Monitoring deep tendon reflexes Maintaining a dark, quiet environment Using a pump to regulate the medication Having calcium gluconate available at the bedside

A pregnant woman is administered medication to treat preterm labor that requires a prescription for calcium gluconate to counter the effects of the drug. Which drug was administered?

Calcium Gluconate

A new mother is diagnosed with depression. Which antidepressant may be prescribed to this client?


Which drug does the nurse anticipate to be prescribed to a client seeking treatment for infertility?


A client at 31 weeks’ gestation is admitted in preterm labor. What class of drugs might the nurse anticipate being prescribed?


A woman who underwent infertility treatment is pregnant with twins. Which drug might have been responsible?


A baby was born with a single-lobed brain and also had neural tube defects. Which drug treatment in the client during her gestation might have caused this condition?


What is the drug of choice for a client who wants to abort her pregnancy at three months of gestation?

Correct3 Mifepristone

A head nurse teaches a group of nursing students about the physiologic changes that may occur during pregnancy. What statement by a nursing student indicates effective teaching?

Renal blood flow is doubled during the third trimester, which increases the glomerular filtration rate.

An infertile client is found to have a hormonal deficiency at the pituitary level. Which fertility drug may be prescribed to treat infertility?


An ultrasound scan of a baby shows that the proximal tubule in the kidney is not well developed. Which drug treatment in the mother during her pregnancy might have caused this condition in the baby?

Angiotensin-converting enzyme inhibitors

A client has been receiving oxytocin to augment labor. For what adverse reaction caused by a prolonged oxytocin infusion should the nurse monitor the client?

Water intoxication

A pregnant client with a history of hypertension is treated with an angiotensin-converting enzyme inhibitor. Which teratogenic effect of angiotensin-converting enzyme (ACE) inhibitors is the neonate at risk for?

Skull hyperplasia

An ultrasound scan of a 7-month-pregnant woman indicates fetal death. Which drug should be given to the client to evacuate the contents of the uterus?


A client consumes alcohol during pregnancy. Which condition does the nurse anticipate to be seen in the newborn?


A client in active labor becomes very uncomfortable and asks a nurse for pain medication. Nalbuphine is prescribed. How does this medication relieve pain?

By acting on opioid receptors to reduce pain

A tocolytic was administered to a woman to inhibit labor and maintain pregnancy. Which nursing interventions would be beneficial to this client? Select all that apply.

The drug should not be administered on a long term basis. The client’s vital signs and fetal heart rate should be monitored regularly. The dose and route of administration should be determined

A 63-year-old woman with the diagnosis of estrogen receptor-positive cancer of the breast undergoes lumpectomy and radiation therapy, and tamoxifen is prescribed. The client asks the nurse how long she will have to take the medication. How will the nurse respond?

You’ll need to take it for 5 years, after which it will be discontinued."

A postpartum woman treated with methylergonovine complained of dizziness, has low blood pressure, and has passed out. Which initial nursing action would help this client?

Notify the primary healthcare provider

Oral contraceptives are prescribed for a client who smokes heavily. What side effect should the nurse warn the client might occur?

Blood clots

Which drug has an effect opposite to that of misoprostol?


A pregnant woman was diagnosed with hypertension and was administered magnesium sulfate. What drug should be administered to prevent magnesium toxicity?

Calcium gluconate

A nurse is caring for a client who was admitted with the diagnosis of severe preeclampsia and is now receiving an intravenous infusion of magnesium sulfate. What is the classification of this medication?

Central nervous system depressant

Which drug would place a client’s offspring at risk for vaginal cancer?


Which assessments should a nurse perform in a woman who is prescribed clomiphene? Select all that apply.

Reproductive and uterine status Concomitant use of antidepressants Family stability and economic status

A pregnant client with severe preeclampsia is receiving an infusion of magnesium sulfate. What does the nurse identify as the main reason that this medication is administered?


A client who is visiting the family planning clinic is prescribed an oral contraceptive. As part of teaching, the nurse plans to inform the client of the possibility of which adverse effect?

Breakthrough bleeding

A woman reports irregular menses and weight gain. Upon diagnosis, the woman has low hormone levels and is treated with infertility drugs to conceive. Which nursing interventions would be beneficial to this client? Select all that apply.

Monitor vital signs. Encourage the client to track her medications in a journal. Recommend the self-administration of oral drugs.

A postpartum woman treated with methylergonovine complained of dizziness, has low blood pressure, and has passed out. Which initial nursing action would help this client?

Notify the primary healthcare provider

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