HESI RN Maternity |100% Correct| Questions and Verified Answers (2023/2024)
Q: A multigravida client at 41-weeks gestation presents in the labor and delivery unit after a non-stress test indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse p...
HESI RN Maternity |100% Correct| Questions and Verified Answers (2023/2024 ) Q: A multigravida client at 41 -weeks gestation pre sents in the labor and delivery unit after a non-stress test indicated that the fetus is experiencing some difficulties in utero. Which diagnostic test should the nurse prepare the client for additional information about fetal status? Answer: Biophysical profile (BPP). BPP (A) provides data regarding fetal risk surveillance by examining 5 areas: fetal breathing movements, fetal movements, amniotic fluid volume, and fetal tone and heart rate. Q: A client with no prenatal care arrives at the l abor 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? Answer: Date of last normal menst rual period. Evaluating the gestation of the pregnancy (C) takes priority. If the fetus is preterm and the fetal heart pattern is reassuring, the healthcare provider may attempt to prolong the pregnancy and administer corticosteroids to mature the lungs of the fetus. Q: 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? Answer: Come to the clinic today for an ultrasound. Third trimester painless bleeding is characteristic of a placenta previa. Bright red bleeding may be intermittent, occur in gushes, or be co ntinuous. Rarely is the first incidence life -threatening, nor cause for hypovolemic shock. Diagnosis is confirmed by transabdominal ultrasound (A). Q: A new mother is afraid to touch her baby's head for fear of hurting the "large soft spot." Which expla nation should the nurse give to this anxious client? Answer: There's a strong, tough membrane there to protect the baby so you need not be afraid to wash or comb his/her hair. Q: During labor, the nurse determines that a full -term client is demonstrating late decelerations. In which sequence should the nurse implement these nursing actions? (Arrange in order.) Answer: Reposition the client. Provide oxygen via face mask. Increa se IV fluid. Call the healthcare provider. Q: 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? Answer: Put the n ewborn to breast. Putting the newborn to breast (D) will help contract the uterus and prevent a postpartum hemorrhage --this intervention has the highest priority. Q: 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? Answer: Apply firm pressure to sacral area. The discomfort of back labor can be minimized by the application of firm pressure to the sacral area Q: A multigravida client arrives at the labor and delivery unit and tells the nurse that her bag of water has broken. The nurse identifies the presence of meconium fluid on the perineum and determines the fetal heart rate is between 140 to 150 beats/minute. What action should the nurse implement next? Answer: Complete a sterile vaginal exam. A vaginal exam (A) should be performed after the rupture of membranes to determine the presence of a prolapsed cord. Q: The nurse is assessing a client who is having a non -stress test (NST) at 41 -weeks gestation. The nur se determines that the client is not having contractions, the fetal heart rate (FHR) baseline is 144 bpm, and no FHR accelerations are occurring. What action should the nurse take? Answer: Ask the client if she has felt any fetal movement. Q: Just aft er 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? Answer: Provide assistance to the mother to begin breastfee ding as soon as possible after delivery. Q: A healthcare provider informs the charge nurse of a labor and delivery unit that a client is coming to the unit with suspected abruptio placentae. What findings should the charge nurse expect the client to dem onstrate? (Select all that apply.) Answer: Dark, red vaginal bleeding. Increased uterine irritability. A rigid abdomen. Q: 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?
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