MATERNITY HESI TEST BANK 2026
CLINICAL SCRIPT SOLVED
QUESTIONS VERIFIED ANSWERS A+
◉ A client at 8-months gestation tells the nurse that she knows her baby
listens to her, but her husband thinks she is imagining things. What
information should the nurse provide?
Answer: The fetus in utero is capable of hearing and does respond to the
mother's voice.
Rationale:
Fetal hearing and response to sound occurs by 24-weeks gestation, so
the fetus can be soothed by the familiar sound of the mother's voice.
◉ A female client who wants to delivery at home asks the nurse to
explain the role of a nurse-midwife in providing obstetric care. What
information should the nurse provide?
Answer: The pregnancy should progress normally and be considered low
risk.
Rationale:
A nurse midwife is an advanced practice nurse who is prepared to
provide quality perinatal care for a low-risk obstetric client.
◉ What nursing action should be included in the plan of care for a
newborn experiencing symptoms of drug withdrawal ?
,Answer: Swaddle the infant snugly and hold tightly.
Rationale:
An infant experiencing drug withdrawal should be swaddled, wrapped
snugly, or placed in a "kangaroo pouch" to reduce self-stimulation
behaviors and protect skin from abrasions that may occur due to
muscular irritability.
◉ The nurse is teaching a new mother about diet and breastfeeding.
Which instruction is most important to include in the teaching plan?
Answer: Avoid alcohol because it is excreted in breast milk.
Rationale:
Alcohol should be avoided while breastfeeding because, when consumed
by the mother, it is excreted in breast milk.
◉ A primigravida at 12-weeks gestation who just moved to the United
States indicates she has not received any immunizations. Which
immunization(s) should the nurse administer at this time? (Select all that
apply.)
Tetanus.
Rubella.
Diphtheria.
Chickenpox.
, Hepatitis B.
Answer: Correct selections are (A, C, and E).
Rationale:
Vaccines composed of killed viruses may be administered during
pregnancy. Rubella (B) and chickenpox (D) consist of live or attenuated
live viruses which would be contraindicated during pregnancy due to
potential teratogenicity.
◉ A client at 25-weeks gestation tells the nurse that she dropped a
cooking utensil last week and her baby jumped in response to the noise.
What information should the nurse provide?
Answer: The fetus can respond to sound by 24-weeks gestation.
Rationale:
At 24-weeks gestation, the fetus's ability to hear loud environment
sounds can illicit a startle response.
◉ A client at 28-weeks gestation experiences blunt abdominal trauma.
Which parameter should the nurse assess first for signs of internal
hemorrhage?
Answer: Changes in fetal heart rate patterns.
Rationale:
Hypoperfusion of the fetus may be present before the onset of clinical
signs of maternal compromise or shock in a pregnant woman, so the
CLINICAL SCRIPT SOLVED
QUESTIONS VERIFIED ANSWERS A+
◉ A client at 8-months gestation tells the nurse that she knows her baby
listens to her, but her husband thinks she is imagining things. What
information should the nurse provide?
Answer: The fetus in utero is capable of hearing and does respond to the
mother's voice.
Rationale:
Fetal hearing and response to sound occurs by 24-weeks gestation, so
the fetus can be soothed by the familiar sound of the mother's voice.
◉ A female client who wants to delivery at home asks the nurse to
explain the role of a nurse-midwife in providing obstetric care. What
information should the nurse provide?
Answer: The pregnancy should progress normally and be considered low
risk.
Rationale:
A nurse midwife is an advanced practice nurse who is prepared to
provide quality perinatal care for a low-risk obstetric client.
◉ What nursing action should be included in the plan of care for a
newborn experiencing symptoms of drug withdrawal ?
,Answer: Swaddle the infant snugly and hold tightly.
Rationale:
An infant experiencing drug withdrawal should be swaddled, wrapped
snugly, or placed in a "kangaroo pouch" to reduce self-stimulation
behaviors and protect skin from abrasions that may occur due to
muscular irritability.
◉ The nurse is teaching a new mother about diet and breastfeeding.
Which instruction is most important to include in the teaching plan?
Answer: Avoid alcohol because it is excreted in breast milk.
Rationale:
Alcohol should be avoided while breastfeeding because, when consumed
by the mother, it is excreted in breast milk.
◉ A primigravida at 12-weeks gestation who just moved to the United
States indicates she has not received any immunizations. Which
immunization(s) should the nurse administer at this time? (Select all that
apply.)
Tetanus.
Rubella.
Diphtheria.
Chickenpox.
, Hepatitis B.
Answer: Correct selections are (A, C, and E).
Rationale:
Vaccines composed of killed viruses may be administered during
pregnancy. Rubella (B) and chickenpox (D) consist of live or attenuated
live viruses which would be contraindicated during pregnancy due to
potential teratogenicity.
◉ A client at 25-weeks gestation tells the nurse that she dropped a
cooking utensil last week and her baby jumped in response to the noise.
What information should the nurse provide?
Answer: The fetus can respond to sound by 24-weeks gestation.
Rationale:
At 24-weeks gestation, the fetus's ability to hear loud environment
sounds can illicit a startle response.
◉ A client at 28-weeks gestation experiences blunt abdominal trauma.
Which parameter should the nurse assess first for signs of internal
hemorrhage?
Answer: Changes in fetal heart rate patterns.
Rationale:
Hypoperfusion of the fetus may be present before the onset of clinical
signs of maternal compromise or shock in a pregnant woman, so the
