HESI PRACTICE EXAM QUESTIONS
WITH COMPLETE SOLUTIONS
A mother who is breastfeeding her baby receives instructions from the nurse. Which
instruction is most effective to prevent nipple soreness? - ANSWER-The most
common cause of nipple soreness is incorrect positioning of the infant on the breast,
e.g., grasping too little of the areola or grasping only the nipple.
Manually express a small amount of milk before nursing helps soften an engorged
breast and encourages correct infant attachment, but is NOT the BEST answer.
A full term infant is transferred to the nursery from labor and delivery. Which
information is MOST important for the nurse to receive when planning immediate
care for the newborn? - ANSWER-Immediate care is most dependent on the infant's
current status (i.e., Apgar scores at 1 and 5 minutes) and any treatment or
resuscitation that was indicated.
In developing a teaching plan for expectant parents, the nurse plans to include
information about when the parents can expect the infant's fontanels to close. The
nurse bases the explanation on knowledge that for the normal newborn, the.. -
ANSWER-anterior fontanel closes at 12 to 18 months and the posterior by the end of
the second month.
In the normal infant the anterior fontanel closes at 12 to 18 months of age and the
posterior fontanel by the end of the second month. These growth and development
milestones should be memorized to prepare for the NCLEX.
When assessing a client who is at 12-weeks gestation, the nurse recommends that
she and her husband consider attending childbirth preparation classes. When is the
best time for the couple to attend these classes? - ANSWER-at 30 weeks gestation
is closest (of the options) to the time parents would be ready for such classes.
Learning is facilitated by an interested pupil! The couple is most interested in
childbirth toward the end of the pregnancy when they are psychologically ready for
the termination of the pregnancy, and the birth of their child is an immediate concern.
The nurse should encourage the laboring client to begin pushing when.. - ANSWER-
the cervix is completely dilated.
Pushing begins with the second stage of labor, i.e., when the cervix is completely
dilated at 10 cm (C). If pushing begins before the cervix is completely dilated the
cervix can become edematous and may never completely dilate, necessitating an
operative delivery. Many primigravidas begin active labor 100% effaced and then
proceed to dilate.
The nurse is counseling a couple who has sought information about conceiving. For
teaching purposes, the nurse should know that ovulation usually occurs.. -
ANSWER-two weeks before menstruation.
Ovulation occurs 14 days before the first day of the menstrual period. While
ovulation can occur in the middle of the cycle, or 2 weeks after menstruation, this is
, only true for a woman who has a perfect 28-day cycle. For many women, the length
of their menstrual cycle varies.
The nurse caring for a laboring client encourages her to void at least q2h, and
records each time the client empties her bladder. What is the primary reason for
implementing this nursing intervention? - ANSWER-A full bladder can impair the
efficiency of the uterine contractions and impede descent of the fetus during labor.
Also, because of the close proximity of the bladder to the uterus, the bladder can be
traumatized by the descent of the fetus.
The nurse instructs a laboring client to use accelerated-blow breathing. The client
begins to complain of tingling fingers and dizziness. What action should the nurse
take? - ANSWER-Tingling fingers and dizziness are signs of hyperventilation
(blowing off too much carbon dioxide). Hyperventilation is treated by retaining carbon
dioxide. This can be facilitated by breathing into a paper bag or cupped hands.
A 28-year-old client in active labor complains of cramps in her leg. What intervention
should the nurse implement? - ANSWER-Dorsiflexing the foot by pushing the sole of
the foot forward or by standing (if the client is capable), and putting the heel of the
foot on the floor is the best means of relieving leg cramps.
When preparing a class on newborn care for expectant parents, what content should
the nurse teach concerning the newborn infant born at term gestation? - ANSWER-
Vernix is a white, cheesy substance, predominantly located in the skin folds.
Vernix, found in the folds of the skin, is a characteristic of term infants.
Also, Meconium (first stool) is tarry black, Milia (milk dots) is white, pinpoint spots
usually found over the nose and chin which represent blockage of the sebaceous
glands, and Pseudostrabismus (crossed eyes) is normal at birth but should be
corrected if it persists after 6 to 9 months of age.
Twenty-four hours after admission to the newborn nursery, a full-term male infant
develops localized edema on the right side of his head. The nurse knows that, in the
newborn, an accumulation of blood between the periosteum and skull which does
not cross the suture line is a newborn variation known as.. - ANSWER-a
cephalhematoma, caused by forceps trauma and may last up to 8 weeks.
Cephalhematoma, a slight abnormal variation of the newborn, usually arises within
the first 24 hours after delivery. Trauma from delivery causes capillary bleeding
between the periosteum and the skull.
An expectant father tells the nurse he fears that his wife "is losing her mind." He
states she is constantly rubbing her abdomen and talking to the baby, and that she
actually reprimands the baby when it moves too much. What recommendation
should the nurse make to this expectant father? - ANSWER-Let him know that these
behaviors are part of normal maternal/fetal bonding which occur once the mother
feels fetal movement.
These behaviors are positive signs of maternal/fetal bonding.
A new mother who has just had her first baby says to the nurse, "I saw the baby in
the recovery room. She sure has a funny looking head." Which response by the
WITH COMPLETE SOLUTIONS
A mother who is breastfeeding her baby receives instructions from the nurse. Which
instruction is most effective to prevent nipple soreness? - ANSWER-The most
common cause of nipple soreness is incorrect positioning of the infant on the breast,
e.g., grasping too little of the areola or grasping only the nipple.
Manually express a small amount of milk before nursing helps soften an engorged
breast and encourages correct infant attachment, but is NOT the BEST answer.
A full term infant is transferred to the nursery from labor and delivery. Which
information is MOST important for the nurse to receive when planning immediate
care for the newborn? - ANSWER-Immediate care is most dependent on the infant's
current status (i.e., Apgar scores at 1 and 5 minutes) and any treatment or
resuscitation that was indicated.
In developing a teaching plan for expectant parents, the nurse plans to include
information about when the parents can expect the infant's fontanels to close. The
nurse bases the explanation on knowledge that for the normal newborn, the.. -
ANSWER-anterior fontanel closes at 12 to 18 months and the posterior by the end of
the second month.
In the normal infant the anterior fontanel closes at 12 to 18 months of age and the
posterior fontanel by the end of the second month. These growth and development
milestones should be memorized to prepare for the NCLEX.
When assessing a client who is at 12-weeks gestation, the nurse recommends that
she and her husband consider attending childbirth preparation classes. When is the
best time for the couple to attend these classes? - ANSWER-at 30 weeks gestation
is closest (of the options) to the time parents would be ready for such classes.
Learning is facilitated by an interested pupil! The couple is most interested in
childbirth toward the end of the pregnancy when they are psychologically ready for
the termination of the pregnancy, and the birth of their child is an immediate concern.
The nurse should encourage the laboring client to begin pushing when.. - ANSWER-
the cervix is completely dilated.
Pushing begins with the second stage of labor, i.e., when the cervix is completely
dilated at 10 cm (C). If pushing begins before the cervix is completely dilated the
cervix can become edematous and may never completely dilate, necessitating an
operative delivery. Many primigravidas begin active labor 100% effaced and then
proceed to dilate.
The nurse is counseling a couple who has sought information about conceiving. For
teaching purposes, the nurse should know that ovulation usually occurs.. -
ANSWER-two weeks before menstruation.
Ovulation occurs 14 days before the first day of the menstrual period. While
ovulation can occur in the middle of the cycle, or 2 weeks after menstruation, this is
, only true for a woman who has a perfect 28-day cycle. For many women, the length
of their menstrual cycle varies.
The nurse caring for a laboring client encourages her to void at least q2h, and
records each time the client empties her bladder. What is the primary reason for
implementing this nursing intervention? - ANSWER-A full bladder can impair the
efficiency of the uterine contractions and impede descent of the fetus during labor.
Also, because of the close proximity of the bladder to the uterus, the bladder can be
traumatized by the descent of the fetus.
The nurse instructs a laboring client to use accelerated-blow breathing. The client
begins to complain of tingling fingers and dizziness. What action should the nurse
take? - ANSWER-Tingling fingers and dizziness are signs of hyperventilation
(blowing off too much carbon dioxide). Hyperventilation is treated by retaining carbon
dioxide. This can be facilitated by breathing into a paper bag or cupped hands.
A 28-year-old client in active labor complains of cramps in her leg. What intervention
should the nurse implement? - ANSWER-Dorsiflexing the foot by pushing the sole of
the foot forward or by standing (if the client is capable), and putting the heel of the
foot on the floor is the best means of relieving leg cramps.
When preparing a class on newborn care for expectant parents, what content should
the nurse teach concerning the newborn infant born at term gestation? - ANSWER-
Vernix is a white, cheesy substance, predominantly located in the skin folds.
Vernix, found in the folds of the skin, is a characteristic of term infants.
Also, Meconium (first stool) is tarry black, Milia (milk dots) is white, pinpoint spots
usually found over the nose and chin which represent blockage of the sebaceous
glands, and Pseudostrabismus (crossed eyes) is normal at birth but should be
corrected if it persists after 6 to 9 months of age.
Twenty-four hours after admission to the newborn nursery, a full-term male infant
develops localized edema on the right side of his head. The nurse knows that, in the
newborn, an accumulation of blood between the periosteum and skull which does
not cross the suture line is a newborn variation known as.. - ANSWER-a
cephalhematoma, caused by forceps trauma and may last up to 8 weeks.
Cephalhematoma, a slight abnormal variation of the newborn, usually arises within
the first 24 hours after delivery. Trauma from delivery causes capillary bleeding
between the periosteum and the skull.
An expectant father tells the nurse he fears that his wife "is losing her mind." He
states she is constantly rubbing her abdomen and talking to the baby, and that she
actually reprimands the baby when it moves too much. What recommendation
should the nurse make to this expectant father? - ANSWER-Let him know that these
behaviors are part of normal maternal/fetal bonding which occur once the mother
feels fetal movement.
These behaviors are positive signs of maternal/fetal bonding.
A new mother who has just had her first baby says to the nurse, "I saw the baby in
the recovery room. She sure has a funny looking head." Which response by the
