: Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |1
HESI Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family 9th Edition
By JoAnne Silbert-Flagg Test Bank
|GRADED A+| (EXAM READY)
(Solved) SCORE A
A client who had a miscarriage 6 months ago becomes pregnant. Which instruction is most
important for the nurse to provide this client?
o Elevate lower legs while resting.
P a g e 1 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |2
o Increase caloric intake by 200 to 300 calories per day.
o Increase water intake to 8 full glasses per day.
o Take prescribed multivitamin and mineral supplements.
o Take prescribed multivitamin and mineral supplements.
· A client who has had a spontaneous abortion or still birth in the last 1 years should take
multivitamin and mineral supplements and maintain a balanced diet because the previous
pregnancy may have left her nutritionally depleted.
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 an IV solution of terbutaline (Brethine). Which assessment is
the highest priority for the nurse to monitor during the administration of this drug?
o Maternal blood pressure and respirations.
o Maternal and fetal heart rates.
o Hourly urinary output.
o Deep tendon reflexes.
o Maternal and fetal heart rates.
· Terbutaline has effects on receptors. It acts as a sympathomimetic agent stimulating beta 1
receptors which cause tachycardia as a side effect and that is a reason why monitoring maternal
and fetal heart rates is most important when terbutaline is being administered. It also affects
beta 2 receptors which relaxes the uterus and that is the reason for its administration.
P a g e 2 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |3
The nurse is calculating the estimated date of confinement (EDC) using Nägele’s rule for a
client whose last menstrual period started on December 1. Which date is most accurate?
o August 1.
o August 10.
o September 3.
o September 8.
o September 8.
· Calculation of a client's EDC provides baseline data to monitor fetal gestation. Nägele’s rule uses
the formula: subtract 3 months and add 7 days to the first day of the last normal menstrual
period, so December 1 minus 3 months + 7 days is September 8.
Which assessment finding should the nursery nurse report to the pediatric healthcare
provider?
o Blood glucose level of 45 mg/dl.
o Blood pressure of 82/45 mmHg.
o Non-bulging anterior fontanel.
o Central cyanosis when crying.
o Central cyanosis when crying.
· An infant who demonstrates central cyanosis when crying is manifesting poor adaptation to
extrauterine life which should be reported to the healthcare provider for determination of a
possible underlying cardiovascular problem. The other options are expected findings in
newborn.
P a g e 3 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |4
A client is admitted with the diagnosis of total placenta previa. Which finding is most
important for the nurse to report to the healthcare provider immediately?
o Heart rate of 100 beats/minute.
o Variable fetal heart rate.
o Onset of uterine contractions.
o Burning on urination.
o Onset of uterine contractions.
· Total (complete) placenta previa involves the placenta covering the entire cervical os
(opening). The onset of uterine contractions places the client at risk for dilation and placental
separation, which causes painless hemorrhaging. The risk of hemorrhage is the priority.
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 pad are completely saturated and the client is
lying in a 6-inch diameter pool of blood. Which action should the nurse implement next?
o Cleanse the perineum.
o Obtain a blood pressure.
o Palpate the firmness of the fundus.
o Inspect the perineum for lacerations.
o Palpate the firmness of the fundus.
· A firm uterus is needed to control bleeding from the placental site of attachment on the
uterine wall. The nurse should first assess for firmness and massage the fundus as indicated.
P a g e 4 | 99
Childbearing & Childrearing Family Page |1
HESI Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family 9th Edition
By JoAnne Silbert-Flagg Test Bank
|GRADED A+| (EXAM READY)
(Solved) SCORE A
A client who had a miscarriage 6 months ago becomes pregnant. Which instruction is most
important for the nurse to provide this client?
o Elevate lower legs while resting.
P a g e 1 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |2
o Increase caloric intake by 200 to 300 calories per day.
o Increase water intake to 8 full glasses per day.
o Take prescribed multivitamin and mineral supplements.
o Take prescribed multivitamin and mineral supplements.
· A client who has had a spontaneous abortion or still birth in the last 1 years should take
multivitamin and mineral supplements and maintain a balanced diet because the previous
pregnancy may have left her nutritionally depleted.
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 an IV solution of terbutaline (Brethine). Which assessment is
the highest priority for the nurse to monitor during the administration of this drug?
o Maternal blood pressure and respirations.
o Maternal and fetal heart rates.
o Hourly urinary output.
o Deep tendon reflexes.
o Maternal and fetal heart rates.
· Terbutaline has effects on receptors. It acts as a sympathomimetic agent stimulating beta 1
receptors which cause tachycardia as a side effect and that is a reason why monitoring maternal
and fetal heart rates is most important when terbutaline is being administered. It also affects
beta 2 receptors which relaxes the uterus and that is the reason for its administration.
P a g e 2 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |3
The nurse is calculating the estimated date of confinement (EDC) using Nägele’s rule for a
client whose last menstrual period started on December 1. Which date is most accurate?
o August 1.
o August 10.
o September 3.
o September 8.
o September 8.
· Calculation of a client's EDC provides baseline data to monitor fetal gestation. Nägele’s rule uses
the formula: subtract 3 months and add 7 days to the first day of the last normal menstrual
period, so December 1 minus 3 months + 7 days is September 8.
Which assessment finding should the nursery nurse report to the pediatric healthcare
provider?
o Blood glucose level of 45 mg/dl.
o Blood pressure of 82/45 mmHg.
o Non-bulging anterior fontanel.
o Central cyanosis when crying.
o Central cyanosis when crying.
· An infant who demonstrates central cyanosis when crying is manifesting poor adaptation to
extrauterine life which should be reported to the healthcare provider for determination of a
possible underlying cardiovascular problem. The other options are expected findings in
newborn.
P a g e 3 | 99
, : Maternal & Child Health Nursing Care of the
Childbearing & Childrearing Family Page |4
A client is admitted with the diagnosis of total placenta previa. Which finding is most
important for the nurse to report to the healthcare provider immediately?
o Heart rate of 100 beats/minute.
o Variable fetal heart rate.
o Onset of uterine contractions.
o Burning on urination.
o Onset of uterine contractions.
· Total (complete) placenta previa involves the placenta covering the entire cervical os
(opening). The onset of uterine contractions places the client at risk for dilation and placental
separation, which causes painless hemorrhaging. The risk of hemorrhage is the priority.
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 pad are completely saturated and the client is
lying in a 6-inch diameter pool of blood. Which action should the nurse implement next?
o Cleanse the perineum.
o Obtain a blood pressure.
o Palpate the firmness of the fundus.
o Inspect the perineum for lacerations.
o Palpate the firmness of the fundus.
· A firm uterus is needed to control bleeding from the placental site of attachment on the
uterine wall. The nurse should first assess for firmness and massage the fundus as indicated.
P a g e 4 | 99
