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Maternity HESI Test bank (combined red hesi and other sources)
2022\2023
1. An expectant father tells the nurse he fears that his wife is "losing her
mind." He states that she is constantly rubbing her abdomen and talking to
the baby and that she actually reprimands the baby when it moves too
much. Which recommendation should the nurse make to this expectant
father?
A.Suggest that his wife seek professional counseling to deal with her
symp-
toms.
B.Explain that his wife is exhibiting ambivalence about the pregnancy.
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C. Ask him to report similar abnormal behaviors at the next prenatal visit.
D.Reassure him that normal maternal-fetal bonding is occurring.: D)
Reassure him that normal maternal-fetal bonding is occurring.
Rationale:
These behaviors are positive signs of maternal-fetal bonding and do not reflect
ambivalence. No intervention is needed. Quickening, the first perception of fetal
movement, occurs at 17 to 20 weeks of gestation and begins a new phase of
prenatal bonding during the second trimester. Options A and C are not
necessary because the behaviors displayed are normal.
2. The nurse is preparing a laboring client for an amniotomy. Immediately
after the procedure is completed, it is most important for the nurse to
obtain which information?
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A.Maternal blood pressure
B.Maternal temperature
C.Fetal heart rate (FHR)
D.White blood cell count (WBC): C. Fetal heart rate (FHR)
Rationale:
The FHR should be assessed before and after the procedure to detect changes
that may indicate the presence of cord compression or prolapse. An amniotomy
(artificial rupture of membranes [AROM]) is used to stimulate labor when the
condition of the cervix is favorable. The fluid should be assessed for color, odor,
and consistency. Option A should be assessed every 15 to 20 minutes during
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labor but is not specific for AROM. Option B is monitored hourly after the
membranes are ruptured to detect the development of amnionitis. Option D
should be determined for all clients in labor.
3. A nurse receives a shift change report for a newborn who is 12 hours
post-vaginal delivery. In developing a plan of care, the nurse should give
the highest priority to which finding?
A.Cyanosis of the hands and feet
B.Skin color that is slightly jaundiced
C.Tiny white papules on the nose or chin
D.Red patches on the cheeks and trunk: B. Skin color that is slightly jaundiced