HESI MATERNITY OB FINAL EXAM 2024/2025 WITH
QUESTIONS AND VERIFIED CORRECT ANSWERS/ ALREADY
GRADED A++
At 38 weeks' gestation, a primigravid client with poorly controlled diabetes
and severe preeclampsia is admitted for a cesarean birth. The nurse
explains to the client that childbirth helps to prevent which of the following?
1. Neonatal hyperbilirubinemia.
2. Congenital anomalies.
3. Perinatal asphyxia.
4. Stillbirth. - ANSWER 61. 4. Stillbirths caused by placental insufficiency
occur with increased frequency
in women with diabetes and severe preeclampsia. Clients with poorly
controlled
diabetes may experience unanticipated stillbirth as a result of premature
aging of the
placenta. Therefore, labor is commonly induced in these clients before
term. If induction
of labor fails, a cesarean section is necessary. Induction and cesarean
section do not
prevent neonatal hyperbilirubinemia, congenital anomalies, or perinatal
asphyxia.
CN: Reduction of risk potential; CL: Apply
A primigravid client with diabetes at 39 weeks' gestation is seen in the
highrisk clinic. The primary health care provider estimates that the fetus
weighs at least 4,500 g (10 lb). The client asks, "What causes the baby to
be so large?" The nurse's response is based on the understanding that
fetal macrosomia is usually related to which
of the following?
1. Family history of large infants.
2. Fetal anomalies.
3. Maternal hyperglycemia.
4. Maternal hypertension. - ANSWER 62. 3. Maternal hyperglycemia and
poor control of the mother's diabetes mellitus
have been implicated in fetal macrosomia. When the mother is
hyperglycemic, large
amounts of amino acids, free fatty acids, and glucose are transferred to the
fetus.
,Although maternal insulin does not cross the placenta, the fetal pancreas
responds by
hypertrophy of the islet cells of the pancreas. The islet cells produce large
amounts of
insulin, which acts as a growth hormone. A family history of large infants
usually is not
the reason for large-for-gestational-age fetuses in diabetic mothers.
Maternal
hypertension is associated with small-for-gestational-age fetuses because
of
vasoconstriction of the maternal and placental blood vessels.
CN: Physiological adaptation; CL: Apply
With plans to breast-feed her neonate, a pregnant client with insulin-
dependent diabetes asks the nurse about insulin needs during the
postpartum period. Which of the following statements about postpartal
insulin requirements for breast-feeding mothers
should the nurse include in the explanation?
1. They fall significantly in the immediate postpartum period.
2. They remain the same as during the labor process.
3. They usually increase in the immediate postpartum period.
4. They need constant adjustment during the first 24 hours. - ANSWER 63.
1. Insulin needs fall significantly for the first 24 hours postpartum because
the
client has usually been on nothing-by-mouth status for a period of time
during labor and
the labor process has used maternal glycogen stores. If the client breast-
feeds, lower
blood glucose levels decrease the insulin requirements. With insulin
resistance gone,
the client commonly needs little or no insulin during the immediate
postpartum period.
Although the need for insulin decreases during the intrapartum period, the
insulin
requirements fall further during the first 24 hours postpartum. After the first
24 hours
postpartum, insulin requirements may fluctuate markedly, needing
adjustment during the
next few days as the mother's body returns to a nonpregnant state.
CN: Pharmacological and parenteral therapies; CL: Create
,After instruction of a primigravid client at 8 weeks' gestation diagnosed with
class I heart disease about self-care during pregnancy, which of the
following client
statements would indicate the need for additional teaching?
1. "I should avoid being near people who have a cold."
2. "I may be given antibiotics during my pregnancy."
3. "I should reduce my intake of protein in my diet."
4. "I should limit my salt intake at meals." - ANSWER The Pregnant Client
with Heart Disease
64. 3. The client needs a diet that is adequate in protein and calories to
prevent
anemia, which can place additional strain on the cardiac system, further
compromising
the client's cardiac status. The client should avoid contact with people who
have
infections because of the increased risk for developing endocarditis. The
client may
need antibiotics during the pregnancy to prevent endocarditis. Limiting
sodium intake
can help to prevent excessive expansion of blood volume and decrease
cardiac
workload.
CN: Reduction of risk potential; CL: Evaluate
While caring for a primigravid client with class II heart disease at 28 weeks'
gestation, the nurse would instruct the client to contact her primary health
care provider immediately if the client experiences which of the following?
1. Mild ankle edema.
2. Emotional stress on the job.
3. Weight gain of 1 lb (0.45 kg) in 1 week.
4. Increased dyspnea at rest. - ANSWER 65. 4. Increased dyspnea at rest
must be reported immediately because it may be
indicative of increasing congestive heart failure. Mild ankle edema in the
third trimester
is a common finding. However, generalized or pitting edema, suggesting
increasing
congestive heart failure, must be reported immediately. Emotional stress on
the job
, increases cardiac demand. However, it needs to be reported only if the
client
experiences symptoms, such as palpitations or irregular heart rate,
indicating heart
failure related to the increased stress. Weight gain of 1 lb (0.45 kg) per
week is a
normal finding during the third trimester.
CN: Reduction of risk potential; CL: Apply
When developing the collaborative plan of care with the health care
provider for a multigravid client at 10 weeks' gestation with a history of
cardiac disease who was being treated with digitalis therapy before this
pregnancy, the nurse should instruct
the client about which of the following regarding the client's drug therapy
regimen?
1. Need for an increased dosage.
2. Continuation of the same dosage.
3. Switching to a different medication.
4. Addition of a diuretic to the regimen. - ANSWER 66. 2. Unless the client
has cardiac decompensation during the pregnancy, she will
most likely be able to continue taking the same dose of medication. The
client may be
prescribed prophylactic antibiotics, particularly if she has had rheumatic
fever. The
medication would be switched only if digitalis toxicity occurs. A diuretic is
added only
if congestive heart failure is not controlled by sodium and activity
restrictions.
CN: Management of care; CL: Apply
Which of the following anticoagulants would the nurse expect to administer
when caring for a primigravid client at 12 weeks' gestation who has class II
cardiac
disease due to mitral valve stenosis?
1. Heparin.
2. Warfarin.
3. Enoxaparin.
4. Ardeparin. - ANSWER 67. 1. Although there is no completely safe
anticoagulant therapy during pregnancy,
QUESTIONS AND VERIFIED CORRECT ANSWERS/ ALREADY
GRADED A++
At 38 weeks' gestation, a primigravid client with poorly controlled diabetes
and severe preeclampsia is admitted for a cesarean birth. The nurse
explains to the client that childbirth helps to prevent which of the following?
1. Neonatal hyperbilirubinemia.
2. Congenital anomalies.
3. Perinatal asphyxia.
4. Stillbirth. - ANSWER 61. 4. Stillbirths caused by placental insufficiency
occur with increased frequency
in women with diabetes and severe preeclampsia. Clients with poorly
controlled
diabetes may experience unanticipated stillbirth as a result of premature
aging of the
placenta. Therefore, labor is commonly induced in these clients before
term. If induction
of labor fails, a cesarean section is necessary. Induction and cesarean
section do not
prevent neonatal hyperbilirubinemia, congenital anomalies, or perinatal
asphyxia.
CN: Reduction of risk potential; CL: Apply
A primigravid client with diabetes at 39 weeks' gestation is seen in the
highrisk clinic. The primary health care provider estimates that the fetus
weighs at least 4,500 g (10 lb). The client asks, "What causes the baby to
be so large?" The nurse's response is based on the understanding that
fetal macrosomia is usually related to which
of the following?
1. Family history of large infants.
2. Fetal anomalies.
3. Maternal hyperglycemia.
4. Maternal hypertension. - ANSWER 62. 3. Maternal hyperglycemia and
poor control of the mother's diabetes mellitus
have been implicated in fetal macrosomia. When the mother is
hyperglycemic, large
amounts of amino acids, free fatty acids, and glucose are transferred to the
fetus.
,Although maternal insulin does not cross the placenta, the fetal pancreas
responds by
hypertrophy of the islet cells of the pancreas. The islet cells produce large
amounts of
insulin, which acts as a growth hormone. A family history of large infants
usually is not
the reason for large-for-gestational-age fetuses in diabetic mothers.
Maternal
hypertension is associated with small-for-gestational-age fetuses because
of
vasoconstriction of the maternal and placental blood vessels.
CN: Physiological adaptation; CL: Apply
With plans to breast-feed her neonate, a pregnant client with insulin-
dependent diabetes asks the nurse about insulin needs during the
postpartum period. Which of the following statements about postpartal
insulin requirements for breast-feeding mothers
should the nurse include in the explanation?
1. They fall significantly in the immediate postpartum period.
2. They remain the same as during the labor process.
3. They usually increase in the immediate postpartum period.
4. They need constant adjustment during the first 24 hours. - ANSWER 63.
1. Insulin needs fall significantly for the first 24 hours postpartum because
the
client has usually been on nothing-by-mouth status for a period of time
during labor and
the labor process has used maternal glycogen stores. If the client breast-
feeds, lower
blood glucose levels decrease the insulin requirements. With insulin
resistance gone,
the client commonly needs little or no insulin during the immediate
postpartum period.
Although the need for insulin decreases during the intrapartum period, the
insulin
requirements fall further during the first 24 hours postpartum. After the first
24 hours
postpartum, insulin requirements may fluctuate markedly, needing
adjustment during the
next few days as the mother's body returns to a nonpregnant state.
CN: Pharmacological and parenteral therapies; CL: Create
,After instruction of a primigravid client at 8 weeks' gestation diagnosed with
class I heart disease about self-care during pregnancy, which of the
following client
statements would indicate the need for additional teaching?
1. "I should avoid being near people who have a cold."
2. "I may be given antibiotics during my pregnancy."
3. "I should reduce my intake of protein in my diet."
4. "I should limit my salt intake at meals." - ANSWER The Pregnant Client
with Heart Disease
64. 3. The client needs a diet that is adequate in protein and calories to
prevent
anemia, which can place additional strain on the cardiac system, further
compromising
the client's cardiac status. The client should avoid contact with people who
have
infections because of the increased risk for developing endocarditis. The
client may
need antibiotics during the pregnancy to prevent endocarditis. Limiting
sodium intake
can help to prevent excessive expansion of blood volume and decrease
cardiac
workload.
CN: Reduction of risk potential; CL: Evaluate
While caring for a primigravid client with class II heart disease at 28 weeks'
gestation, the nurse would instruct the client to contact her primary health
care provider immediately if the client experiences which of the following?
1. Mild ankle edema.
2. Emotional stress on the job.
3. Weight gain of 1 lb (0.45 kg) in 1 week.
4. Increased dyspnea at rest. - ANSWER 65. 4. Increased dyspnea at rest
must be reported immediately because it may be
indicative of increasing congestive heart failure. Mild ankle edema in the
third trimester
is a common finding. However, generalized or pitting edema, suggesting
increasing
congestive heart failure, must be reported immediately. Emotional stress on
the job
, increases cardiac demand. However, it needs to be reported only if the
client
experiences symptoms, such as palpitations or irregular heart rate,
indicating heart
failure related to the increased stress. Weight gain of 1 lb (0.45 kg) per
week is a
normal finding during the third trimester.
CN: Reduction of risk potential; CL: Apply
When developing the collaborative plan of care with the health care
provider for a multigravid client at 10 weeks' gestation with a history of
cardiac disease who was being treated with digitalis therapy before this
pregnancy, the nurse should instruct
the client about which of the following regarding the client's drug therapy
regimen?
1. Need for an increased dosage.
2. Continuation of the same dosage.
3. Switching to a different medication.
4. Addition of a diuretic to the regimen. - ANSWER 66. 2. Unless the client
has cardiac decompensation during the pregnancy, she will
most likely be able to continue taking the same dose of medication. The
client may be
prescribed prophylactic antibiotics, particularly if she has had rheumatic
fever. The
medication would be switched only if digitalis toxicity occurs. A diuretic is
added only
if congestive heart failure is not controlled by sodium and activity
restrictions.
CN: Management of care; CL: Apply
Which of the following anticoagulants would the nurse expect to administer
when caring for a primigravid client at 12 weeks' gestation who has class II
cardiac
disease due to mitral valve stenosis?
1. Heparin.
2. Warfarin.
3. Enoxaparin.
4. Ardeparin. - ANSWER 67. 1. Although there is no completely safe
anticoagulant therapy during pregnancy,
