HESI Obstetrics/Maternity Practice Exam
Which maternal behavior is the nurse most likely to see when a new mother receives her infant for the first time?
B. Her arms and hands receive the infant and she ten traces the infant's profile with her fingertips.
The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this finding, which intervention should the nurse implement?
C. Encourage the mother to breast-feed frequently.
The nurse is planning preconception care for a new female client. Which information should the nurse provide to the client?
D. Encourage healthy lifestyles for families during pregnancy.
A client who is in the 2nd trimester of pregnancy tells the nurse that she wants to use herbal therapy. Which response is best for the nurse to provide?
D. It is important that you want to take part in your care.
A woman who thinks she could be pregnant calls her neighbor, a nurse, to ask when she could use a home pregnancy test to diagnose pregnancy. Which response is appropriate?
A. a home pregnancy test can be used right after your first missed period.
The nurse is providing discharge teaching for a client who is 24 hours postpartum. The nurse explains to the client that her vaginal discharge will change from red to pink and then to white. The client asks, "What if I start having red bleeding after it changes?" What should the nurse instruct the client to do?
A. Reduce activity level and notify healthcare provider.
Client teaching is an important part of the maternity nurse's role. Which factor has the greatest influence on successful teaching of the gravid client?
A. The client's readiness to learn
A multigravida at 41-weeks gestation presents in the L & D after a NST indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse prepare the client for additional information about eh fetal status?
A. a BPP
Twenty-four hours after admission to the newborn nursery, a full-term male infant develops localized edema on the right side of his head. The nurse knows that, in the newborn, an accumulation of blood between the periosteum and skull which does not cross the suture line is a newborn variation known as
A. a cephalhematoma, caused by forceps trauma and may last up to 8 weeks.
A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first?
A. Bathe the infant with antimicrobial soap.
The nurse is teaching a woman how to use her basal body temp pattern as a tool to assist her in conceiving a child. Which temperature pattern indicates the occurrence of ovulation, and therefore, the best time for intercourse to ensure conception?
A. Between the time the temp falls and rises.
A client at 28-weeks gestation calls the antepartal clinic and states that she is experiencing a small amount of vaginal bleeding which she describes as bright red. She further states that she is not experiencing any uterine contractions or abdominal pain. What instruction should the nurse provide?
A. Come to the clinic today for an ultrasound.
A pregnant client with mitral stenosis Class III is prescribed complete bedrest. The client asks the nurse. "Why must I stay in bed all the time?" Which response is the best for the nurse to provide this client?
A. Complete bedrest decreases oxygen needs and demands on the heart muscle tissue.
A woman with Type 2 diabetes mellitus becomes pregnant, and her oral hypoglycemic agents are discontinued. Which intervention is most important for the nurse to implement?
A. Describe diet changes that can improve the management of her diabetes.
The nurse is caring for a woman with a previously diagnosed heart disease who is in the second stage of labor. Which assessment findings are of greatest concern?
A. Edema, basilar rales, and an irregular pulse.
The nurse attempts to help an unmarried teenager deal with her feelings following a spontaneous abortion at 8-weeks gestation. What type of emotional response should the nurser anticipate?
A. Grief related to her perceptions about the loss of this child.
Which action should the nurse implement when preparing to measure the fundal height of a pregnant client?
A. Have the client empty her bladder.
Which nursing intervention is most helpful in relieving postpartum uterine contractions or "afterpains?"
A. Lying prone with a pillow on the abdomen
On admission to the prenatal clinic, a 23-year-old woman tells the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. This client's expected date of delivery (EDD) is
A. November 22
A client in active labor is admitted with preeclampsia. Which is assessment finding is most significant in planning this client's care?
A. Patellar reflex 4+
A client receiving epidural anesthesia begins to experience nausea and become pale and clammy. What intention should the nurse implement first?
A. Raise the foot of the bed.
The nurse is performing a gestational age assessment on a full-term newborn during the first hour of transition using the Ballard scale. Based on this assessment, the nurse determines that the neonate has a maturity rating at 40-weeks. What findings should the nurse identify to determine if the neonate is SGA?
A. admission weight of 4 lbs. B. Head to heel length of 17 inches. C. frontal occipital circumference of 12.5 inches.
A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take?
A. apply cold compresses to both breasts for comfort.
A full term infant is admitted to the newborn nursery. After careful assessment, the nurse suspects that the infant may have an esophageal atresia. Which symptoms are this newborn likely to exhibit?
A. choking, coughing, and cyanosis.
A multigravida client arrives at the L & D unit and tells the nurse tht her "bag of water" has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the FHR is between 140 -150 BPM. What action should the nurse implement next?
A. complete a sterile vaginal exam.
A healthcare provider informs the charge nurse of L & D that a client is coming to the unit w/suspected abruptio placentae. What findings should the charge nurse expect the client to demonstrate?
A. dark red vaginal bleeding D. increased uterine irritability. F. a rigid abdomen.
The healthcare provider prescribes terbulatine (Brethine) for a client in preterm labor. Before initiating this prescription, it is most important for the nurse to assess the client for which condition?
A. gestational diabetes
immediately after birth a newborn infant is suctioned, dried, and placed under a radiant warmer. The infant has spontaneous respirations and the nurse assesses an apical heart rate of 80 BPM and respirations of 20 BPM. What action should the nurse perform next?
A. initiate positive pressure ventilation.
When explaining "postpartum blues" to a client who is 1 day postpartum, which symptoms should the nurse include in the teaching plan? (Select all that apply.) A. Mood swings. B. Panic attacks. C. Tearfulness. D. Decreased need for sleep. E. Disinterest in the infant.
A. mood swings C. tearfulness
A 42-week gestational client is receiving an IV infusion of oxytocin (Pitocin) to augment early labor. The nurse should d/c the oxytocin infusion for which pattern of contractions?
A. transition labor with contraction every 2 min, lasting 90 seconds each.
The nurse is counseling a couple who has sought information about conceiving. For teaching purposes, the nurse should know that ovulation usually occurs
A. two weeks before menstruation.
The nurse is assessing a 3-day old infant with a cephalohematoma in the newborn nursery. Which assessment finding should the nurse report to the healthcare provider?
A. yellowish tinge to the skin
A new mother asks the nurse, "How do I know my daughter is getting enough breast milk? Which explanation will the nurse provide?
B. "your milk is sufficient if the baby is voiding pale straw-colored urine 6-10 times a day.
A pregnant client tells the nurse that the first day of her LMP was 8/2/06. Based on Nagele's rule, what is the estimated date of delivery?
B. 5/9/07
The nurse caring for a laboring client encourage her to void at least q2h, and records each time the client empties her bladder.What is the primary reason for implementing this nursing intervention?
B. An over-distended bladder could be traumatized during labor, as well as prolong the progress of labor.
A client in active labor complains of cramps in her leg. What intervention should the nurse implement?
B. Extend the leg and dorsiflex the foot.
A full term infant is transferred to the nursery from L & D. Which information is most important for the nurse to receive when planning immediate care for the newborn?
B. Infant's condition at birth and treatment received.
A client who is attending antepartum classes asks the nurse why her healthcare provider has prescribed iron tablets. The nurse's response is based on what knowledge?
B. It is difficult to consume 18 mg of additional iron by diet alone.
A client with gestational hypertension is in active labor and receiving an infusion of mag sulfate. Which drug should the nurse have available for signs of potential toxicity?
B. calcium gluconate
A client who has an autosomal dominant inherited disorder is exploring family planning options and the risk of transmission of the disorder to the infant. The nurse's response should be based on what information?
B. each pregnancy carries a 50% chance of inheriting the disorder.
A primagravida at 40 weeks gestation is receiving oxytocin (Pitocin) to augment labor. What adverse effect should the nurse monitor for during infusion of Pitocin?
B. hyperstimulation
During a prenatal visit, the nurse discusses with a client the effects of smoking on the fetus. When compared with nonsmokers, mothers who smoke during pregnancy tend to produce infants who have
B. lower birth weights
A female client w/insulin dependent diabetes arrives at the clinic seeking a plan to get pregnant in approx 6 mos. She tells the nurse that she wants to have an uncomplicated pregnancy and a healthy baby. What information should the nurse share with the client?
B. maintain blond sugar levels in a constant range WNL during pregnancy.
a 30 y/o G2P1 client is admitted to the hospital at 26-weeks gestation in preterm labor. She is given a dose of terbulatine sulfate (Brethine) 0.25 mg subq. Which assessment is the highest priority for the nurse to monitor during the administration of this drug?
B. maternal and fetal HRs
A 30-year old gravida 2. para 1 client is admitted to the hospital at 26-weeks gestation in preterm labor. She is started on am IV solution of terbutaline (Brethine). Which assessment is the highest priority for the nurse to monitor during the administration of the drug?
B. maternal and fetal heart rates
The nurse identifies crepitus when examining the chest of a newborn who was delivered vaginally. Which further assessment should the nurse perform?
B. observe for an asymmetrical Moro reflex.
The nurse should explain toa 30 y/o gravid client that alpha fetoprotein testing is recommended for which purpose?
B. screen for neural tube defects.
A full-term infant is transferred to the nursery from L & D. Which information is most important for the nurses to receive when planning immediate care for the newborn?
B. the infant's condition at birth and treatment received.
A newborn infant is brought to the nursery from the birthing suite. The nurse notices that the infant is breathing satifactorily but appears dusky. What action should the nurse take first?
C. Check the infant's oxygen saturation rate.
A 24-hour old newborn has pink papular rash with vesicles superimposed on the thorax, back, and abdomen. What action should the nurse implement?
C. Document the finding in the newborns record.
The nurse is assessing the umbilical cord of a newborn. Which finding constitutes a normal finding?
C. 3 vessels: 2 arteries and a vein.
The nurse is teaching breastfeeding to prospective parents in a childbirth education class. Which instruction should the nurse include as content int the class?
C. Feed your baby every 2 to 3 hours or on demand, whichever comes first.
The nurse is teaching care of the newborn to a group of prospective parents and describes the need for administering antibiotic ointment into the eyes of the newborn. Which infectious organism will this treatment prevent from harming the infant?
C. Gonorrhea
The nurse is counseling a woman who wants to become pregnant. The woman tells the nurse she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. The nurse correctly calculates the woman's next fertile period will be
C. January 30-31
A 38-week primagravida who works as a secretary and sits at a computer 8 hours a day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in the lower extremities?
C. Move about every hour
A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28-weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg subcutaneously to stop her labor contractions. The nurse plans to monitor for which primary side effect of terbutaline sulfate?
C. Tachycardia and a feeling of nervousness
A new mother who has just had her first baby says to the nurse, "I saw the baby in the recovery room. She has a funny looking head". Which response by the nurse is the best?
C. That is normal, the head will return to a round shape within 7-10 days.
When preparing a newborn care for expectant parents, what content should the nurse teach concerning the newborn infant born at term gestation?
C. Vernix is a white, cheesy substance, predominately located in the skin folds.
A client at 32-weeks gestation is hospitalized with severe pregnancy-induced hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms. Which assessment finding would indicate that therapeutic drug level has been achieved?
C. a decrease in RR from 24 to 16.
A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The nurse knows that the most likely presenting symptom for a pediatric client with AIDS is
C. a persistent cold
The nurse is preparing a client w/a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside?
C. a sterile glove D. amniotic hook F. a doppler
The nurse is preparing a client w/a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside?
C. a sterile glove D. an aminhook F. lubricant
A 4-week old premature infant has been receiving epoetin alfa for the last 3 weeks. Which assessment finding indicated to the nurse that the drug is effective?
C. changes in apical heart rate from the 180s to the 140s
A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?
C. correctly place the infant on the breast
A client with no prenatal care arrives at the labor unit screaming, "the baby is coming". The nurse performs a vaginal examination that reveals the cervix is 3 centimeters dilated and 75% effaced. What additional information is most important for the nurse to obtain?
C. date of last normal menstrual period.
A client at 32-weeks gestation is diagnosed with preeclampsia. Which assessment finding is most indicative of an impending convulsion?
C. epigastric pain
The nurse instructs a laboring client to use accelerated-blow breathing. The client begins to complain of tingling fingers and dizziness. What action should the nurse take?
C. have the client breath into her cupped hands
At 14-weeks gestation, a client arrives at the Er complaining of a dull pain in the RLQ. The nurse obtains a blood sample and initiates and IV. 30 minutes after admission, the client reports feeling a sharp abdominal pain and a shoulder pain. assessment findings include diaphoresis HR 120, BP 86/48. What action should the nurse implement ?
C. increase rate of IV fluids
The nurse assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?
C. monitor bleeding from IV sites.
A client 30-weeks gestation, complaining of pressure over the pubic area, is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on these data, which intervention should the nurse implement first?
C. obtain a specimen for urine analysis
A client is admitted w/the diagnosis of total placenta previa. Which finding is is most important for the nurse to report to the healthcare provider immediately?
C. onset of uterine contractions
A client who delivered an infant an hour ago tells the nurse that she feels wet underneath her buttock. The nurse notes that both perineal pads are completely saturated and the client is lying in a 6-inch diameter pool of blood. Which action should the nurse implement next?
C. palpate the firmness of the fundus
Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60. What action will the nurse take?
C. place the woman in a lateral position.
The nurse observes a new mother is rooming in and caring for her newborn infant. What observation indicates the need for further teaching?
C. places the infant prone in the bassinet.
A couple, concerned because the woman has not been able to conceive, is referred to a healthcare provider for a fertility workup and a hysterosalpingography is scheduled. Which complaint would indicate to the nurse that the woman's fallopian tubes are patent?
C. shoulder pain
A 23 y/o client who is receiving Medicaid benefits is pregnant with her 1st child. Based on knowledge of the stats r/t infant mortality, which plan should the nurse implement w/this client?
C. teach the client why keeping prenatal care appointments is important.
The nurse should encourage the laboring client to begin pushing when
C. the cervix is completely dilated
A 30-year old multiparous woman who has a 3-y/o and a newborn tells the nurse,"My son is so jealous of my daughter. I don't know how I'll ever manage both children when I get home". How should the nurse respond?
D. "regression in behaviors in the older child is a typical reaction so he needs attention at this time".
A pregnant women comes to the prenatal clinic for an initial visit. In reviewing her childbearing Hx, the client indicates that she has delivered premature twins, one full-term baby, and has had no abortions. What GTPAL should the nurse document in this client's record?
D. 3-1-1-0-3
The nurse is calculating the EDC using Nagel's rule for a client whose LMP started on 12/1. Which date is most accurate?
D. 9/8
A primagravida client who is 5 cm dilated, 90% effaced, and at 0 station is requesting an epidural for pain relief. Which assessment finding is most important to the nurse to report to the healthcare provider?
D. A platelet count of 67,000/mm3.
The nurse is assessing a client who is having a NST at 41-weeks gestation. The nurse determines that the client is not having contractions, the FHR baseline is 144 bpm, and no FHR accels are occurring. What action should the nurse take?
D. Ask the client if she has felt any fetal movement.
When assessing a client who is 12-weeks gestation, the nurse recommends the she and her husband consider attending childbirth preparation classes. What is the best time for the couple to attend these classes?
D. At 30 weeks gestation.
One hour after giving birth to an 8-pound infant, a client's lochia rubra has increased from small to large and her fundus is boggy despite massage. The client's pulse is 84 beats/minute and blood pressure is 156/96. The healthcare provider prescribes Methergine 0.2 mg IM × 1. What action should the nurse take immediately?
D. Call the healthcare provider to question the prescription.
A client at 32-weeks gestation comes to the prenatal clinic with complaints of pedal edema, dyspnea, fatigue, and a moist cough. Which question is most important for the nurse to ask the client?
D. Do you have a history of rheumatic fever?
An expectant father tells the nurse he fears that his wife "is losing her mind". He states she is constantly rubbing her abdomen and talking to the baby and that she actually reprimands the baby when it moves too much. What recommendation should the nurse make to the expectant father?
D. Let him know that these behaviors are part of normal maternal/fetal bonding which occurs once the mother feels fetal movement.
A client who gave birth to a healthy 8 pound infant 3 hours ago is admitted to the postpartum unit. Which nursing plan is best in assisting the mother to bond with her newborn infant?
D. Meet the mother's physical needs and demonstrate warmth toward the infant.
Just after delivery, a new mother tells the nurse, "I was unsuccessful breastfeeding my first child, but I would like to try with this baby." Which intervention is best for the nurse to implement first?
D. Provide assistance to the mother to begin breastfeeding as soon as possible after delivery.
An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while her husband is screaming for someone to help his wife. Which intervention has the highest priority?
D. Put the newborn to breast.
After each feeding, a 3-day-old newborn is spitting up large amounts of Enfamil Newborn Formula, a nonfat cow's milk formula. The pediatric healthcare provider changes the neonate's formula to Similac Soy Isomil Formula, a soy protein isolate based infant formula. What information should the nurse provide to the mother about the newly prescribed formula?
D. Similac Soy Isomil Formula is a soy-based formula that contains sucrose.
A woman who had a miscarriage 6 mos ago becomes pregnant. Which instruction is most important for the nurse to provide this client?
D. Take prescribed multivitamin and mineral supplements.
A new mother is afraid to touch her baby's head for fear of hurting the 'large soft spot." Which explanation should the nurse give to this anxious client?
D. There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb his/her hair.
A couple has been trying to conceive for 9 months without success. Which information obtained from the clients is most likely to have an impact on the couple's ability to conceive?
D. They use lubricants with each sexual encounter to decrease friction.
A 35-year-old primagravida client with severe preeclampia is receiving magnesium sulfate via continuous IV infusion. Which assessment data would indicate to the nurse that the client is experiencing magnesium sulfate toxicity?
D. Urine output 90 ml/4 hours.
The nurse is preparing to give an enema to a laboring client. Which client would require the most caution when carrying out this procedure?
D. a 40-week primagravida who presents at 100% effacement, 3 cm dilation, and a -1 station.
In developing a teaching plan for expectant parents, the nurse plans to include information about when the parents can expect the infant's fontanels to close. The nurse bases the explanation on knowledge that for the normal newborn, the
D. anterior fontanel closes at 12-18 mos and the posterior fontanel by the end of the second month.
A 40-week gestation primigravida client is being induced with an oxytocin (Pitocin) secondary infusion and complains of pain in her lower back. Which intervention should the nurse implement?
D. apply firm pressure to the sacral area.
Which assessment finding should the nursery nurse report to the ped healthcare provider?
D. central cyanosis when crying
What action should the nurse implement to decrease the client's risk for hemorrhage after a C/S?
D. check the firmness of the uterus Q15 min.
While breastfeeding, a new mother strokes the top of her baby's head and asks the nurse about the baby's swollen scalp. The nurse responds that the swelling is caput succedaneum. Which additional information should the nurse provide this new mother?
D. the scalp edema will subside in a few days after birth.
