MATERNITY HESI ASSIGNMENT EXAM UPDATED
ACTUAL QUESTIONS WITH CORRECT ANSWERS
Question 1.
Which finding in the medical history of a post-partum client should the nurse withhold the
administration of a routine standing order for methylergonovine maleate (Methergine)?
ANSWER
Pregnancy induced hypertension.
Rationale: Methergine is used for post-partum bleeding. A client's history of
pregnancy-induced hypertension is a contraindication for Methergine which causes
vasoconstriction and increases blood pressure, so the routine standing order should be
withheld and reported to the healthcare provider.
Question 2.
A client at 8-months gestation tells the nurse that she knows her baby listens to her, but her husband
thinks she is imagining things. What information should the nurse provide?
ANSWER
The fetus in utero is capable of hearing and does respond to the mother's voice.
Rationale: Fetal hearing and response to sound occurs by 24-weeks gestation, so the fetus can
be soothed by the familiar sound of the mother's voice.
Question 3.
A female client who wants to delivery at home asks the nurse to explain the role of a nurse-midwife in
providing obstetric care. What information should the nurse provide?
ANSWER
The pregnancy should progress normally and be considered low risk.
Rationale: A nurse midwife is an advanced practice nurse who is prepared to provide quality
perinatal care for a low-risk obstetric client.
, Question 4.
What nursing action should be included in the plan of care for a newborn experiencing symptoms of
drug withdrawal ?
ANSWER
Swaddle the infant snugly and hold tightly.
Rationale: An infant experiencing drug withdrawal should be swaddled, wrapped snugly, or
placed in a "kangaroo pouch" to reduce self-stimulation behaviors and protect skin from
abrasions that may occur due to muscular irritability.
Question 5.
The nurse is teaching a new mother about diet and breastfeeding. Which instruction is most important
to include in the teaching plan?
ANSWER
Avoid alcohol because it is excreted in breast milk.
Rationale: Alcohol should be avoided while breastfeeding because, when consumed by the
mother, it is excreted in breast milk.
Question 6.
A primigravida at 12-weeks gestation who just moved to the United States indicates she has not
received any immunizations. Which immunization(s) should the nurse administer at this time? (Select
all that apply.)
Tetanus. Rubella. Diphtheria. Chickenpox. Hepatitis B.
ANSWER
Correct selections are (A, C, and E).
Rationale: Vaccines composed of killed viruses may be administered during pregnancy.
Rubella (B) and chickenpox (D) consist of live or attenuated live viruses which would be
contraindicated during pregnancy due to potential teratogenicity.
Question 7.
A client at 25-weeks gestation tells the nurse that she dropped a cooking utensil last week and her
baby jumped in response to the noise. What information should the nurse provide?
ANSWER
The fetus can respond to sound by 24-weeks gestation.
Rationale: At 24-weeks gestation, the fetus's ability to hear loud environment sounds can illicit
a startle response.
ACTUAL QUESTIONS WITH CORRECT ANSWERS
Question 1.
Which finding in the medical history of a post-partum client should the nurse withhold the
administration of a routine standing order for methylergonovine maleate (Methergine)?
ANSWER
Pregnancy induced hypertension.
Rationale: Methergine is used for post-partum bleeding. A client's history of
pregnancy-induced hypertension is a contraindication for Methergine which causes
vasoconstriction and increases blood pressure, so the routine standing order should be
withheld and reported to the healthcare provider.
Question 2.
A client at 8-months gestation tells the nurse that she knows her baby listens to her, but her husband
thinks she is imagining things. What information should the nurse provide?
ANSWER
The fetus in utero is capable of hearing and does respond to the mother's voice.
Rationale: Fetal hearing and response to sound occurs by 24-weeks gestation, so the fetus can
be soothed by the familiar sound of the mother's voice.
Question 3.
A female client who wants to delivery at home asks the nurse to explain the role of a nurse-midwife in
providing obstetric care. What information should the nurse provide?
ANSWER
The pregnancy should progress normally and be considered low risk.
Rationale: A nurse midwife is an advanced practice nurse who is prepared to provide quality
perinatal care for a low-risk obstetric client.
, Question 4.
What nursing action should be included in the plan of care for a newborn experiencing symptoms of
drug withdrawal ?
ANSWER
Swaddle the infant snugly and hold tightly.
Rationale: An infant experiencing drug withdrawal should be swaddled, wrapped snugly, or
placed in a "kangaroo pouch" to reduce self-stimulation behaviors and protect skin from
abrasions that may occur due to muscular irritability.
Question 5.
The nurse is teaching a new mother about diet and breastfeeding. Which instruction is most important
to include in the teaching plan?
ANSWER
Avoid alcohol because it is excreted in breast milk.
Rationale: Alcohol should be avoided while breastfeeding because, when consumed by the
mother, it is excreted in breast milk.
Question 6.
A primigravida at 12-weeks gestation who just moved to the United States indicates she has not
received any immunizations. Which immunization(s) should the nurse administer at this time? (Select
all that apply.)
Tetanus. Rubella. Diphtheria. Chickenpox. Hepatitis B.
ANSWER
Correct selections are (A, C, and E).
Rationale: Vaccines composed of killed viruses may be administered during pregnancy.
Rubella (B) and chickenpox (D) consist of live or attenuated live viruses which would be
contraindicated during pregnancy due to potential teratogenicity.
Question 7.
A client at 25-weeks gestation tells the nurse that she dropped a cooking utensil last week and her
baby jumped in response to the noise. What information should the nurse provide?
ANSWER
The fetus can respond to sound by 24-weeks gestation.
Rationale: At 24-weeks gestation, the fetus's ability to hear loud environment sounds can illicit
a startle response.
