HESI MATERNITY&PEDIATRICS ACTUAL EXAM WITH
LATEST UPDATES 2023 QUESTION AND ANSWERS.
A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is
prescribed. Which instruction should the nurse provide to this client? - ANSWER-
Breastfeed the infant, ensuring that both breasts are completely emptied.
An insulin-dependent client with gestational diabetes mellitus is in the second stage of
labor. What supplies will the delivery nurse gather for care of the newborn? (Select all
that apply.) - ANSWER-Erythromycin ointment
Scale
Measuring tape
Blood glucose testing kit
A client is admitted to the hospital at 28 weeks of gestation in preterm labor. The nurse
administers three doses of terbutaline sulfate, 0.25 mg subcutaneously. Which side
effects will the nurse anticipate for this client? (Select all that apply.) - ANSWER-Feeling
of nervousness
Tachycardia
Restlessness
The nurse is interviewing a newly pregnancy client who is 16-years old. Which client
statement indicates teaching is necessary for a safe pregnancy? (Select all that apply.) -
ANSWER-"I hate milk."
"I only want to gain 10 pounds."
"I refuse to wear maternity clothes."
The nurse is preparing to administer an IV pain medication to a client in labor. What will
the nurse include in this client's plan of care related to the administration of the
medication? (Select all that apply.) - ANSWER-Administer the medication only when the
client is having a contraction.
Assess the fetal heart rate (FHR) for 10 minutes prior to administering the pain
medication.
The nurse is providing care to a laboring client with a GTPAL of 75015. The client
reports contractions every 2 to 8 minutes, of moderate intensity, for the past 6 hours.
Her cervical exam upon admission is 4/0/75%, and membranes are intact. In the next
20 minutes, what supplies will the nurse gather for this client? (Select all that apply.) -
ANSWER-Amnihook
1000 mL of D5LR
Oxytocin
The nurse is providing care to a postpartum client with O negative blood who is antibody
positive. The newborn is O negative. What is the best nursing action for this client? -
ANSWER-Ask the mother if she desires any more children.
,The nurse is preparing a newborn for discharge. There is an order for a hepatitis B
vaccination prior to discharge. When planning to administer the vaccination, what
information must the nurse obtain from the infants chart? - ANSWER-Site of the vitamin
K injection
The nurse instructs a laboring client to use accelerated blow breathing. The client
begins to complain of tingling fingers and dizziness. Which action should the nurse take
next? - ANSWER-Have the client breathe into her cupped hands.
The nurse is counseling a couple who has sought information about conceiving. The
couple asks the nurse to explain when ovulation usually occurs. Which statement by the
nurse is correct? - ANSWER-Two weeks before menstruation
A mother expresses fear about changing the infant's diaper after circumcision. What
information should the nurse include in the teaching plan? - ANSWER-Place petroleum
ointment around the glans with each diaper change and cleansing.
The clinic nurse takes a phone call from a client who reports she is at 12 weeks
gestation. Which statements indicate to the nurse the client may be having a
spontaneous abortion? (Select all that apply.) - ANSWER-"I am having severe
abdominal cramping."
"I am passing blood clots from my vagina."
A 25-year-old client has a positive pregnancy test. One year ago she had a
spontaneous abortion at 3 months of gestation. What will the nurse document in the
client's chart regarding her GTPAL? - ANSWER-20010
A client in active labor is becoming increasingly fearful because her contractions are
occurring more often than she had expected. Her partner is also becoming anxious.
What is the nurse's best action? - ANSWER-Asking the client and her partner if they
would like the nurse to stay in the room
What specific instructions will the nurse include in the pregnancy client's teaching plan
who is also human immunodeficiency virus (HIV) positive? (Select all that apply.) -
ANSWER-Use condoms when having sex.
Zidovudine prescription helps decrease risk of fetal exposure
Breastfeeding is not recommended.
A 41-week multigravida is receiving oxytocin to augment labor. Contractions are firm
and occurring every 5 minutes, with a 30- to 40-second duration. The fetal heart rate
increases with each contraction and returns to baseline after the contraction. What is
the next nursing action? - ANSWER-Increase the rate of the oxytocin infusion.
On admission to the prenatal clinic, a client tells the nurse that her last menstrual period
began on February 15 and that previously her periods were regular (28-day cycle). Her
,pregnancy test is positive. What is this client's expected date of birth? - ANSWER-
November 22
A client at 39 weeks gestation overhears her health care provider say to the nurse, "Her
Bishop score is 10." The client asks the nurse, "What does that mean?" What is the
nurse's best response? - ANSWER-"Your cervix is ready for labor."
The clinic nurse is reviewing signs of pre-term labor with a client at 28 weeks gestation.
Which client statements indicate to the nurse further teaching is necessary? (Select all
that apply.) - ANSWER-"I expect the discharge from my vagina will change from thick to
brown over the next two weeks."
"The baby's movements will decrease and be almost still from here on out."
"I should expect low back pain and diarrhea as the baby grows."
When a new mother receives her infant for the first time, which behavior is most
reassuring to the nurse? - ANSWER-Her arms and hands receive the infant and she
then traces the infant's profile with her fingertips.
A client presents to the emergency department with complaints of severe lower left
abdominal pain and vaginal spotting. Her last menstrual period was 5 weeks ago. What
are the nurse's next actions? (Select all that apply.) - ANSWER-Check the results of the
HCG test.
Ask the client to describe the color of the vaginal bleeding.
Ask the client if she has ever been diagnosed with pelvic inflammatory disease.
Draw the client's blood for a type and cross match.
The nurse is providing care to a primipara's whose most recent cervical exam at 0700
was 6/+1/100. Assuming an expected progression of labor, approximately what time will
the client enter into the second stage of labor? - ANSWER-1100
The nurse is teaching a group of teen girls about their reproductive system and
pregnancy. What risk factors for an unplanned pregnancy will the nurse include in the
teaching plan for these girls? (Select all that apply.) - ANSWER-Poverty
Family problems
Early onset of menarche
Sexual exploration
Group think
A new mother is having trouble breastfeeding her newborn. The child is making frantic
rooting motions and will not grasp the nipple. Which intervention should the nurse
implement? - ANSWER-Encourage the mother to stop feeding for a few minutes and
comfort the infant.
The nurse is providing care to a laboring client at term. Which client statement indicates
to the nurse that the client is entering stage two of labor? - ANSWER-"I feel like I have
to push down."
, The clinic nurse is reviewing phone messages left from postpartum clients during the
lunch break. Which calls will the nurse return before the others? (Select all that apply.) -
ANSWER-The mother who reports her vaginal discharge went from brown to bright red.
The mother who reports her vaginal flow smells "like a chicken farm."
The breast-feeding mother who reports redness and a painful right breast.
A newly pregnant client is crying loudly and reports to the clinic nurse over the phone
that she took a prescribed narcotic pain medication 4 weeks ago. What is the nurse's
next response? - ANSWER-"When did your last period begin?"
During stage two of labor, what assessments must the labor nurse perform? (Select all
that apply.) - ANSWER-Fetal heart rate before the contraction
Fetal heart rate during the contraction
Fetal heart rate after the contraction
Frequency of contractions
Duration of contractions
Uterine tone between contractions
A primigravida at term presents to the labor and delivery unit smiling and states to the
nurse, "I am in labor." The nurse assesses the client's cervical dilation and finds it is
2/50%/-1. The fetal heart rate is stable at 135 to 145 beats/min, and membranes are
intact. Maternal vital signs are stable. What are the nursing actions for this phase/stage
of labor? (Select all that apply.) - ANSWER-Encourage the mother to ambulate.
Have the mother use slow, deep breathing with contractions.
Encourage the mother to urinate every 1 to 2 hours.
A new mother who has just had her first baby says to the nurse, "I saw the baby in the
recovery room. The head is really funny looking." Which response by the nurse is best?
- ANSWER-"That is normal. The head will return to a round shape within 7 to 10 days."
The nurse is providing care to a 1-hour-old neonate born to mother who took insulin
throughout her pregnancy. Which conditions will the nurse include in the infant's
assessment throughout its hospitalization? (Select all that apply.) - ANSWER-
Hypoglycemia
Respiratory distress syndrome
Congenital anomalies
A mother who is breastfeeding her baby receives instructions from the nurse. Which
instructions are most effective in preventing nipple soreness? (Select all that apply.) -
ANSWER-Massage a small amount of medical-grade lanolin into the nipple.
Ensure that the baby is positioned correctly for latching on.
The clinic nurse is performing a fundal height assessment on a client in her third
trimester. The client states to the nurse, "I am feeling very dizzy when you are pressing
LATEST UPDATES 2023 QUESTION AND ANSWERS.
A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is
prescribed. Which instruction should the nurse provide to this client? - ANSWER-
Breastfeed the infant, ensuring that both breasts are completely emptied.
An insulin-dependent client with gestational diabetes mellitus is in the second stage of
labor. What supplies will the delivery nurse gather for care of the newborn? (Select all
that apply.) - ANSWER-Erythromycin ointment
Scale
Measuring tape
Blood glucose testing kit
A client is admitted to the hospital at 28 weeks of gestation in preterm labor. The nurse
administers three doses of terbutaline sulfate, 0.25 mg subcutaneously. Which side
effects will the nurse anticipate for this client? (Select all that apply.) - ANSWER-Feeling
of nervousness
Tachycardia
Restlessness
The nurse is interviewing a newly pregnancy client who is 16-years old. Which client
statement indicates teaching is necessary for a safe pregnancy? (Select all that apply.) -
ANSWER-"I hate milk."
"I only want to gain 10 pounds."
"I refuse to wear maternity clothes."
The nurse is preparing to administer an IV pain medication to a client in labor. What will
the nurse include in this client's plan of care related to the administration of the
medication? (Select all that apply.) - ANSWER-Administer the medication only when the
client is having a contraction.
Assess the fetal heart rate (FHR) for 10 minutes prior to administering the pain
medication.
The nurse is providing care to a laboring client with a GTPAL of 75015. The client
reports contractions every 2 to 8 minutes, of moderate intensity, for the past 6 hours.
Her cervical exam upon admission is 4/0/75%, and membranes are intact. In the next
20 minutes, what supplies will the nurse gather for this client? (Select all that apply.) -
ANSWER-Amnihook
1000 mL of D5LR
Oxytocin
The nurse is providing care to a postpartum client with O negative blood who is antibody
positive. The newborn is O negative. What is the best nursing action for this client? -
ANSWER-Ask the mother if she desires any more children.
,The nurse is preparing a newborn for discharge. There is an order for a hepatitis B
vaccination prior to discharge. When planning to administer the vaccination, what
information must the nurse obtain from the infants chart? - ANSWER-Site of the vitamin
K injection
The nurse instructs a laboring client to use accelerated blow breathing. The client
begins to complain of tingling fingers and dizziness. Which action should the nurse take
next? - ANSWER-Have the client breathe into her cupped hands.
The nurse is counseling a couple who has sought information about conceiving. The
couple asks the nurse to explain when ovulation usually occurs. Which statement by the
nurse is correct? - ANSWER-Two weeks before menstruation
A mother expresses fear about changing the infant's diaper after circumcision. What
information should the nurse include in the teaching plan? - ANSWER-Place petroleum
ointment around the glans with each diaper change and cleansing.
The clinic nurse takes a phone call from a client who reports she is at 12 weeks
gestation. Which statements indicate to the nurse the client may be having a
spontaneous abortion? (Select all that apply.) - ANSWER-"I am having severe
abdominal cramping."
"I am passing blood clots from my vagina."
A 25-year-old client has a positive pregnancy test. One year ago she had a
spontaneous abortion at 3 months of gestation. What will the nurse document in the
client's chart regarding her GTPAL? - ANSWER-20010
A client in active labor is becoming increasingly fearful because her contractions are
occurring more often than she had expected. Her partner is also becoming anxious.
What is the nurse's best action? - ANSWER-Asking the client and her partner if they
would like the nurse to stay in the room
What specific instructions will the nurse include in the pregnancy client's teaching plan
who is also human immunodeficiency virus (HIV) positive? (Select all that apply.) -
ANSWER-Use condoms when having sex.
Zidovudine prescription helps decrease risk of fetal exposure
Breastfeeding is not recommended.
A 41-week multigravida is receiving oxytocin to augment labor. Contractions are firm
and occurring every 5 minutes, with a 30- to 40-second duration. The fetal heart rate
increases with each contraction and returns to baseline after the contraction. What is
the next nursing action? - ANSWER-Increase the rate of the oxytocin infusion.
On admission to the prenatal clinic, a client tells the nurse that her last menstrual period
began on February 15 and that previously her periods were regular (28-day cycle). Her
,pregnancy test is positive. What is this client's expected date of birth? - ANSWER-
November 22
A client at 39 weeks gestation overhears her health care provider say to the nurse, "Her
Bishop score is 10." The client asks the nurse, "What does that mean?" What is the
nurse's best response? - ANSWER-"Your cervix is ready for labor."
The clinic nurse is reviewing signs of pre-term labor with a client at 28 weeks gestation.
Which client statements indicate to the nurse further teaching is necessary? (Select all
that apply.) - ANSWER-"I expect the discharge from my vagina will change from thick to
brown over the next two weeks."
"The baby's movements will decrease and be almost still from here on out."
"I should expect low back pain and diarrhea as the baby grows."
When a new mother receives her infant for the first time, which behavior is most
reassuring to the nurse? - ANSWER-Her arms and hands receive the infant and she
then traces the infant's profile with her fingertips.
A client presents to the emergency department with complaints of severe lower left
abdominal pain and vaginal spotting. Her last menstrual period was 5 weeks ago. What
are the nurse's next actions? (Select all that apply.) - ANSWER-Check the results of the
HCG test.
Ask the client to describe the color of the vaginal bleeding.
Ask the client if she has ever been diagnosed with pelvic inflammatory disease.
Draw the client's blood for a type and cross match.
The nurse is providing care to a primipara's whose most recent cervical exam at 0700
was 6/+1/100. Assuming an expected progression of labor, approximately what time will
the client enter into the second stage of labor? - ANSWER-1100
The nurse is teaching a group of teen girls about their reproductive system and
pregnancy. What risk factors for an unplanned pregnancy will the nurse include in the
teaching plan for these girls? (Select all that apply.) - ANSWER-Poverty
Family problems
Early onset of menarche
Sexual exploration
Group think
A new mother is having trouble breastfeeding her newborn. The child is making frantic
rooting motions and will not grasp the nipple. Which intervention should the nurse
implement? - ANSWER-Encourage the mother to stop feeding for a few minutes and
comfort the infant.
The nurse is providing care to a laboring client at term. Which client statement indicates
to the nurse that the client is entering stage two of labor? - ANSWER-"I feel like I have
to push down."
, The clinic nurse is reviewing phone messages left from postpartum clients during the
lunch break. Which calls will the nurse return before the others? (Select all that apply.) -
ANSWER-The mother who reports her vaginal discharge went from brown to bright red.
The mother who reports her vaginal flow smells "like a chicken farm."
The breast-feeding mother who reports redness and a painful right breast.
A newly pregnant client is crying loudly and reports to the clinic nurse over the phone
that she took a prescribed narcotic pain medication 4 weeks ago. What is the nurse's
next response? - ANSWER-"When did your last period begin?"
During stage two of labor, what assessments must the labor nurse perform? (Select all
that apply.) - ANSWER-Fetal heart rate before the contraction
Fetal heart rate during the contraction
Fetal heart rate after the contraction
Frequency of contractions
Duration of contractions
Uterine tone between contractions
A primigravida at term presents to the labor and delivery unit smiling and states to the
nurse, "I am in labor." The nurse assesses the client's cervical dilation and finds it is
2/50%/-1. The fetal heart rate is stable at 135 to 145 beats/min, and membranes are
intact. Maternal vital signs are stable. What are the nursing actions for this phase/stage
of labor? (Select all that apply.) - ANSWER-Encourage the mother to ambulate.
Have the mother use slow, deep breathing with contractions.
Encourage the mother to urinate every 1 to 2 hours.
A new mother who has just had her first baby says to the nurse, "I saw the baby in the
recovery room. The head is really funny looking." Which response by the nurse is best?
- ANSWER-"That is normal. The head will return to a round shape within 7 to 10 days."
The nurse is providing care to a 1-hour-old neonate born to mother who took insulin
throughout her pregnancy. Which conditions will the nurse include in the infant's
assessment throughout its hospitalization? (Select all that apply.) - ANSWER-
Hypoglycemia
Respiratory distress syndrome
Congenital anomalies
A mother who is breastfeeding her baby receives instructions from the nurse. Which
instructions are most effective in preventing nipple soreness? (Select all that apply.) -
ANSWER-Massage a small amount of medical-grade lanolin into the nipple.
Ensure that the baby is positioned correctly for latching on.
The clinic nurse is performing a fundal height assessment on a client in her third
trimester. The client states to the nurse, "I am feeling very dizzy when you are pressing
