2020 HESI OB (+)
The nurse is analyzing the three-generation pedigree below. In which generation is the proband?
II.
A woman asks a nurse about presymptomatic genetic testing for Huntington's disease. The nurse should base her response on which of the following?
If the woman is positive for the gene for Huntington's, she will develop the disease later in life.
A primigravid adolescent client at approximately 15 weeks' gestation who is visiting the prenatal clinic with her mother is to undergo alphafetoprotein (AFP) screening. When developing the teaching plan for this client, the nurse should include which of the following?
Increased levels of AFP are associated with neural tube defects
. The day after delivery a woman, whose fundus is firm at 1 cm below the umbilicus and who has moderate lochia, tells the nurse that something must be wrong, "All I do is go to the bathroom." Which of the following is an appropriate nursing response?
Inform the client that polyuria is normal
The nurse administers RhoGAM to a postpartum client. Which of the following is the goal of the medication?
Inhibit the mother's active immune response
Which of the following actions is appropriate for the nurse to perform when caring for a Chinese-speaking woman in active labor?
Inquire regarding the woman's pain level
A nurse massages the atonic uterus of a woman who delivered 1 hour earlier. The nurse identifies the nursing diagnosis: Risk for injury related to uterine atony. Which of the following outcomes indicates that the client's condition has improved?
Moderate lochia flow
An 18-week gestation client telephones the obstetrician's office stating, "I'm really scared. I think I have breast cancer. My breasts are filled with tumors." The nurse should base the response on which of the following?
Nodular breast tissue is normal during pregnancy.
A G2P2002, who is postpartum 6 hours from a spontaneous vaginal delivery, is assessed. The nurse notes that the fundus is firm at the umbilicus, there is heavy lochia, and perineal sutures are intact. Which of the following actions should the nurse take at this time?
Notify the woman's primary health care provider.
The nurse is providing acupressure to provide pain relief to a woman in labor. Where is the best location for the acupressure to be applied?
On the medial aspect of the lower leg
Which of the following exercises should be taught to a pregnant woman who complains of backaches?
Pelvic tilting.
The nurse assesses a 2-day postpartum, breastfeeding client. The nurse notes blood on the mother's breast pad and a crack on the mother's nipple. Which of the following actions should the nurse perform at this time?
Provide the woman with a tube of topical lanolin.
A 37-week gravid client states that she noticed a "white liquid" leaking from her breasts during a recent shower. Which of the following nursing responses is appropriate at this time?
Reassure the mother that this is normal in the third trimester.
A woman, 24 hours postpartum, is complaining of profuse diaphoresis. She has no other complaints. Which of the following actions by the nurse is appropriate?
Reassure the woman that this is normal.
A woman in her third trimester advises the nurse that she wishes to breastfeed her baby, "but I don't think my nipples are right." Upon examination, the nurse notes that the client has inverted nipples. Which of the following actions should the nurse take at this time?
Refer the client to a lactation consultant for advice.
A nurse midwife has advised a 39-week gestation gravid to take evening primrose oil 2500 mg daily as a complementary therapy. This suggestion was made because evening primrose has been shown to perform which of the following actions?
Ripen the cervix
A client informs the nurse that she intends to bottlefeed her baby. Which of the following actions should the nurse encourage the client to perform?
Wear a supportive bra 24 hours a day
A 36-week gestation gravid client is complaining of dyspnea when lying flat. Which of the following is the likely clinical reason for this complaint?
Fundal height.
The nurse is evaluating the involution of a woman who is 3 days postpartum. Which of the following findings would the nurse evaluate as normal?
Fundus 3 cm below the umbilicus, lochia serosa.
A breastfeeding client, G10P6408, delivered 10 minutes ago. Which of the following assessments is most important for the nurse to perform at this time?
Fundus.
A nurse is caring for the following four laboring patients. Which client should the nurse be prepared to monitor closely for signs of postpartum hemorrhage (PPH)?
G2P1001, prolonged first stage of labor
. A client, who had no prenatal care, delivers a 10 lb 10 oz-baby boy whose serum glucose result 1 hour after delivery was 20 mg/dL. Based on these data, which of the following tests should the mother have at her 6-week postpartum checkup?
Glucose tolerance test
The nurse is caring for a client who had a cesarean section under spinal anesthesia less than 2 hours ago. Which of the following nursing actions is appropriate at this time?
Have her turn and deep breathe every 2 hours
The nurse is caring for an Orthodox Jewish woman in labor. It would be appropriate for the nurse to include which of the following in the plan of care?
Provide the woman with a long-sleeved hospital gown
A 38-week gestation client, Bishop score 1, is advised by her nurse midwife to take evening primrose daily. The office nurse advises the client to report which of the following side effects that has been attributed to the oil?
Skin rash.
Which of the following recommendations would be most helpful to suggest to a primigravid client at 37 weeks' gestation who is complaining of leg cramps?
Straighten the knee and flex the toes toward the chin
When teaching a primigravid client how to do Kegel exercises, the nurse explains that the expected outcome of these exercises is to:
Strengthen the perineal muscles
A client who is 3 days postpartum asks the nurse, "When may my husband and I begin having sexual relations again?" The nurse should encourage the couple to wait until after which of the following has occurred?
The client has had her six-week postpartum check-up.
A woman who has had multiple miscarriages is advised to go through genetic testing. The client asks the nurse the rationale for this recommendation. The nurse should base his or her response on which of the following?
The majority of miscarriages are caused by genetic defects.
A G1P0, 8 cm dilated, is to receive pain medication. The health care practitioner has decided to order an opiate analgesic with an analgesic-potentiating medication. Which of the following medications would the nurse expect to be ordered as the analgesic-potentiating medication?
Phenergan (promethazine).
A client, G2P1001, 5 cm dilated and 40% effaced, has just received an epidural. Which of the following actions is important for the nurse to make at this time?
Place a wedge under the woman's side
A woman is seeking genetic counseling during her pregnancy. She has a strong family history of diabetes mellitus. She wishes to have an amniocentesis to determine whether or not she is carrying a baby who will "develop diabetes." Which of the following replies by the nurse would be most appropriate for the nurse to make?
"Although diabetes does have a genetic component, diet and exercise also determine whether or not someone is diabetic."
The nurse is providing anticipatory guidance to a woman in her second trimester regarding signs/symptoms that she might experience in the coming weeks. Which of the following comments by the client indicates that further teaching is needed?
"During the third trimester I may experience persistent headache."
Which of the following client statements indicates a need for additional teaching about selfcare during pregnancy?
"I should sit in a hot tub for 20 minutes to relax after working."
Which statement by a gravid client who is a carrier for muscular dystrophy, an X-linked recessive disease, indicates that she understands the implications of her status?
"If I have a girl, she will be healthy."
A woman had a cesarean section yesterday. She states that she needs to cough but that she is afraid to. Which of the following is the nurse's best response?
"If you support your incision with a pillow, coughing should hurt less."
During a routine clinic visit, a 25-year-old multigravid client who initiated prenatal care at 10 weeks' gestation and is now in her third trimester states, "I've been having strange dreams about the baby. Last week I dreamed he was covered with hair." The nurse should tell the mother
"It's not uncommon to have dreams about the baby, particularly in the third trimester."
A primigravid client at 36 weeks' gestation tells the nurse that she has been experiencing insomnia for the past 2 weeks. Which of the following suggestions would be most helpful?
Practice relaxation techniques before bedtime.
A primigravid client at 28 weeks' gestation tells the nurse that she and her husband wish to drive to visit relatives who live several hundred miles away. Which of the following recommendations by the nurse would be best?
"Taking the trip is okay if you stop every 1 to2 hours and walk."
A woman, who has undergone amniocentesis, has been notified that her baby is XX with a 14/21 Robertsonian chromosomal translocation. The nurse helps the woman to understand which of the following?
. It is likely that the baby will be unable to have children when she grows up
A woman is receiving patient-controlled analgesia (PCA) post-cesarean section. Which of the following must be included in the patient teaching?
. The client should report any feelings of nausea or itching to the nurse.
Which of the following statements best identifies the rationale for why the nurse reinforces the need for continued prenatal care throughout the pregnancy with an adolescent primigravid client?
Pregnant adolescents are at high risk for pregnancy-induced hypertension.
Which of the following statements by the nurse would be most appropriate when responding to a primigravid client who asks, "What should I do about this brown discoloration across my nose and cheeks?"
"This usually disappears after delivery."
A breastfeeding client, 7 weeks postpartum, complains to an obstetrician's triage nurse that when she and her husband had intercourse for the first time after the delivery, "I couldn't stand it. It was so painful. The doctor must have done something terrible to my vagina." Which of the following responses by the nurse is appropriate?
"Women who breastfeed often have vaginal dryness. A vaginal lubricant may remedy your discomfort."
A primigravid client at 32 weeks' gestation is enrolled in a breast-feeding class. Which of the following statements indicate that the client understands the breast-feeding education? Select all that apply
-"I can hold my baby several different ways during feedings." -"If I breast-feed, my uterus will return to prepregnancy size more quickly." -"I need to feed my baby when I see feeding cues and not wait until she is crying."
Which of the following actions would the nurse expect to perform immediately before a woman is to have regional anesthesia? Select all that apply.
-Assess fetal heart rate -Infuse 1000 cc of Ringer's lactate. -Have woman empty her bladder
Which of the following nonpharmacological interventions recommended by nurse midwives may help a client at full term to go into labor? Select all that apply.
-Engage in sexual intercourse. -Ingest evening primrose oil -Massage the breast and nipples
During a genetic evaluation, it is discovered that the woman is carrying one autosomal dominant gene for a serious late adult-onset disease while her partner's history is unremarkable. Based on this information, which of the following family members should be considered high risk and in need of genetic counseling? Select all that apply.
-The woman's fetus. -. The woman's sisters -The woman's brothers. -The woman's parents.
On vaginal examination, it is noted that a woman with a well-functioning epidural is in the second stage of labor. The station is 2 and the baseline fetal heart rate is 130 with no decelerations. Which of the following nursing actions is appropriate at this time?
. Administer oxygen via face mask at 8 to 10 liters per minute.
A multigravid, postpartum woman reports severe abdominal cramping whenever she nurses her infant. Which of the following responses by the nurse is appropriate?
. Discuss the action of breastfeeding hormones
Which of the following vital sign changes should the nurse highlight for a pregnant woman's obstetrician?
Prepregnancy blood pressure (BP) 100/60 and third trimester BP 140/90.
A client is receiving IV heparin for deep vein thrombosis. Which of the following medications should the nurse obtain from the pharmacy to have on hand in case of heparin overdose?
Protamine
The nurse is caring for a breastfeeding mother who asks advice on foods that will provide both vitamin A and iron. Which of the following should the nurse recommend?
11⁄2 cup raw broccoli.
When performing Leopold's maneuvers on a primigravid client at 22 weeks' gestation, the nurse performs the first maneuver to do which of the following?
Determine what is in the fundus
A woman states that she frequently awakens with "painful leg cramps" during the night. Which of the following assessments should the nurse make?
Dietary evaluation.
When teaching a primigravid client at 24 weeks' gestation about the diagnostic tests to determine fetal wellbeing, which of the following should the nurse include?
A fetal biophysical profile involves assessments of breathing movements, body movements, tone, amniotic fluid volume, and fetal heart rate reactivity.
A 3-day postpartum client, who is not immune to rubella, is to receive the vaccine at discharge. Which of the following must the nurse include in her discharge teaching regarding the vaccine?
A) The woman should not become pregnant for at least 4 weeks
A 3-day-postpartum breastfeeding woman is being assessed. Her breasts are firm and warm to the touch. When asked when she last fed the baby her reply is, "I fed the baby last evening. I let the nurses feed him in the nursery last night. I needed to rest." Which of the following actions should the nurse take at this time?
A)Encourage the woman exclusively to breastfeed her
A breastfeeding woman, 11⁄2 months postdelivery, calls the nurse in the obstetrician's office and states, "I am very embarrassed but I need help. Last night I had an orgasm when my husband and I were making love. You should have seen the milk. We were both soaking wet. What is wrong with me?" The nurse should base the response to the client on which of the following?
The same hormone stimulates orgasms and the milk ejection reflex.
A 36-year-old primigravid client at 22 weeks' gestation without any complications to date is being seen in the clinic for a routine visit. The nurse should assess the client's fundal height to:
Estimate the fetal gestational age
A breastfeeding mother states that she has sore nipples. In response to the complaint, the nurse assists with "latch on" and recommends that the mother do which of the following?
Rotate infant positions at each feed
A client is 1-day post-cesarean section with spinal anesthesia. Even though the nurse advised against it, the client has had the head of her bed in high Fowler's position since delivery. Which of the following complications would the nurse expect to see in relation to the client's action?
Severe postural headache
A woman is informed that she is a carrier for Tay Sachs disease, an autosomal recessive illness. What is her phenotype?
She exhibits no symptoms of the disease
The nurse is discussing the importance of doing Kegel exercises during the postpartum period. Which of the following should be included in the teaching plan?
She should practice by stopping the urine flow midstream every time she voids
A nurse concludes that a woman is in the latent phase of labor. Which of the following signs/symptoms would lead a nurse to that conclusion?
The woman talks and laughs during contractions
The nurse in the obstetric clinic received a telephone call from a bottlefeeding mother of a 3-day-old. The client states that her breasts are firm, red, and warm to the touch. Which of the following is the best action for the nurse to advise the client to perform?
Intermittently apply ice packs to her axillae and breasts.
The nurse is assessing fetal position for a 32-year-old client in her eighth month of pregnancy. As shown below, the fetal position can be described as which of the following?
Left occipital transverse.
During a home visit, the nurse assesses a client 2 weeks after delivery. Which of the following signs/symptoms should the nurse expect to see?
Lochia alba.
A breastfeeding woman has been diagnosed with retained placental fragments 4 days postdelivery. Which of the following breastfeeding complications would the nurse expect to see?
Low milk supply
Which of the following laboratory values would the nurse expect to see in a normal postpartum woman?
White blood cell count 16,000 cells/mm3.
A breastfeeding client is being seen in the emergency department with a hard, red, warm nodule in the upper outer quadrant of her left breast. Her vital signs are: T 104.6ºF, P 100, R 20, and BP 110/60. She has a recent history of mastitis and is crying in pain. Which of the following nursing diagnoses is highest priority?
infection
The nurse is interpreting the results of a fetal blood sampling test. Which of the following reports would the nurse expect to see?
pH of 7.30.
. Which of the following statements is true about breastfeeding mothers as compared to bottlefeeding mothers?
Breastfeeding mothers have decreased incidence of diabetes mellitus later in life.
A client who is post-cesarean section for severe preeclampsia is receiving magnesium sulfate via IV pump and morphine sulfate via patient-controlled anesthesia (PCA) pump. The nurse enters the room on rounds and notes that the client is not breathing. Which of the following actions should the nurse perform first?
Call a code.
When planning a class for primigravid clients about the common discomforts of pregnancy, which of the following physiologic changes of pregnancy should the nurse include in the teaching plan?
Cardiac output increases by 25% to 50% during pregnancy
The nurse is caring for a postpartum client who experienced a second-degree perineal laceration at delivery 2 hours ago. Which of the following interventions should the nurse perform at this time?
Apply an ice pack to the perineum.
A nurse is caring for women from four different countries. Which of the women is most likely to request that her head be kept covered throughout her hospitalization?
Arabic woman.
A breastfeeding woman has been counseled on how to prevent engorgement. Which of the following actions by the mother shows that the teaching was effective?
B). She feeds her baby every 2 to 3 hours.
To prevent infection, the nurse teaches the postpartum client to perform which of the following tasks?
B)Change the peripad at each voiding.
A client just delivered the placenta pictured below. The nurse will document that the woman delivered which of following placentas?
Battledore placenta
Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client?
Colostrum is usually secreted by about the 16th week of gestation.
A 2-day-postpartum breastfeeding woman states, "I am sick of being fat. When can I go on a diet?" Which of the following responses is appropriate?
D)"Many mothers lose weight when they breastfeed because the baby consumes about 600 calories a day."
A patient, G2P1102, who delivered her baby 8 hours ago, now has a temperature of 100.2ºF. Which of the following is the appropriate nursing intervention at this time?
D)Encourage intake of water and other fluids.
The nurse monitors his or her postpartum clients carefully because which of the following physiological changes occurs during the early postpartum period?
Decreased blood volume
Which of the following recommendations would be the most appropriate preventive measure to suggest to a primigravid client at 30 weeks' gestation who is experiencing occasional heartburn?
Eat smaller and more frequent meals during the day
A nurse has just taken a family history on a 10-week gravid client and created the family pedigree shown below. Which of the following actions should the nurse take at this time?
Encourage the doctor to send her for genetic counseling.
A 25-year-old woman, G0 P0000, enters the infertility clinic stating that she has just learned she is positive for the BRCA1 and the BRCA2 genes. She asks the nurse what her options are for getting pregnant and breastfeeding her baby. The nurse should base her reply on which of the following?
Fertility of women who carry the BRCA1 and BRCA2 genes is similar to that of unaffected women.
The practitioner is performing a fetal scalp stimulation test. Which of the following fetal responses would the nurse expect to see?
Fetal heart acceleration.
After the nurse reviews the physician's explanation of amniocentesis with a multigravid client, which of the following indicates that the client understands a serious risk of the procedure.?
Fetal organ malformations.
A nurse is assisting an anesthesiologist who is inserting an epidural catheter. Which of the following positions should the nurse assist the woman into?
Fetal position
A woman, G1 P0000, 40 weeks' gestation, entered the labor suite stating that she is in labor. Upon examination it is noted that the woman is 2 cm dilated, 30% effaced, contracting every 12 min 30 sec. Fetal heart rate is in the 140s with good variability and spontaneous accelerations. What should the nurse conclude when reporting the findings to the primary health care practitioner?
The woman is in early labor and could be sent home.
A woman with postpartum depression has been prescribed Zoloft (sertraline) 50 mg daily. Which of the following should the client be taught about the medication?
Therapeutic effect may be delayed a week or more.
A 3-day-postpartum client questions why she is to receive the rubella vaccine before leaving the hospital. Which of the following rationales should guide the nurse's response?
A)The client's obstetric status is optimal for receiving the vaccine.
Immediately following administration of an epidural anesthesia, the nurse must monitor the mother for which of the following?
Drop in blood pressure.
