Maternal/Newborn HESI Review Questions with Answers Latest Updates 2024
Daily kick counts •Fetal movement is a good sign of fetal well-being.
•Clients do not always feel the fetus movement; however, they should be able to feel at least 10 movements in any given 2-hour period.
•Client teaching should be done by the third trimester and needs to include instructions on how
to count movement and to notify the provider if they have no fetal movement for a period (like
12 hours).
•If fetal movement does not reach 10 movements in one hour, the client is instructed to drink a
few ounces of orange juice and monitor for another hour (total 2 hours).
•Remember, anything that depresses the mom’s CNS will also depress the fetal CNS.
Ultrasound •Ultrasound is a non-invasive procedure that is safe throughout the pregnancy. The test checks
different things in each of the 3 trimesters. Remember: 1st trimester is 1 through 13 weeks; 2nd
trimester is 14 through 26 weeks; and 3rd trimester is 27 through 40 weeks. Review your HESI
manual on page 251 to see what is assessed during each of the trimesters!
•One of the most common reasons for doing an ultrasound in the 2nd trimester (14-26 weeks) is
to assess if fetal growth matches the gestational age. Remember that all normal fetus grows the same up to 20 weeks because organs are being formed. Individual growth and weight vary after 20 weeks.
•Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they
should have an empty bladder.
•An ultrasound is an ideal test if the pregnant client is unsure of the date of her last menstrual period.
Biophysical Profile (BPP) •BPP is an accurate indicator of fetal well-being. Higher the score the better.
•There are five assessments done do determine a BPP score. Four ultrasound data includes fetal breathing, movement, heart rate, amniotic fluid index, and then the result of a non-
stress test.
Amniocentesis •An amniocentesis may be done for several reasons. It is an invasive procedure so there needs
to be a medical indication for one. The risk may be minimized by using ultrasound during the
procedure. If a client complains of low back pain with pelvic cramping following the procedure, it is imperative that they are assessed for complications from the procedure.
•RhoGam should be given following the procedure if the client is RH negative.
•If done for genetic concerns, remember that a high alphafetalprotein (AFP) may indicate a neural tubal defect; low may indicate trisomy 21
•Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they
should have an empty bladder.
•Also used for assessing fetal lung maturity - L/S & S/A ratios 2:1 (see table 10-4) Maternal serum (MS) A.Alpha-fetoprotein (AFP) •Neural tube defects (NTD’s) •All pregnant women should receive testing.
•Folate taken preconceptionally and during early pregnancy has lowered the incidence of NTD.
•Alpha-fetoprotein is detected in mom’s serum from 14-34 weeks gestation.
B.Multiple marker screens for chromosomal abnormalities •Tested between 11-14 weeks gestation.
C.Coombs’ test for RH incompatibility •A coombs test is to determine if a Rh-negative mom has built antibodies against a Rh
positive fetus after delivery. If mom has a negative indirect coomb and her baby is Rh
positive, then she should receive RhoGam within 72 hours of delivery.
Non-Stress Test (NST) used antepartum •Purpose is to evaluate if fetus is receiving enough oxygen to respond to movement. This can
be a valuable test to assess fetal well-being in the high risk individuals.
•Interpretation criteria: FHR must increase with fetal movement for 15 seconds by 15 beats per
minute. Reactive = 2 acceleration in 20 minute period. Nonreactive = Heart rate did not respond adequately to fetal movement
Contraction Stress Test (CST) used antepartum •Purpose is to evaluate if fetus can tolerate the stress of contractions. Evaluation of fetal heart
rate response to contraction by looking for any pattern of fetal heart rate deceleration (Late decels) that indicate that the fetus does not have enough oxygen in reserve to make it completely through the contractions.
•Interpretation criteria: requires 3 contractions in 10 minutes.
oNegative ~ No late decels or variable decels noted ~ IDEAL results
oPositive ~ late decels are present with 50% or more contraction.
Diabetes mellitus (DM) •DM is a common risk factor in the childbearing age that automatically becomes a high risk pregnancy. There can be complications for mom as well as for the baby.
•It is important that the client is educated about the change in insulin requirements as a result
of the pregnancy. During the first trimester, maternal insulin needs decrease; during the second and third trimester, maternal insulin needs increase due to insulin resistance. After delivery, placental hormone levels drop abruptly, and insulin requirements decrease. It is important that the mom does not experience DKA because it can lead to fetal death! This client may require a cesarean section due to the risk of having a macrosomia fetus. Also, the diabetic client needs to be assessed closely for infection because it could lead to mom becoming hyperglycemic. The use of oral contraception after delivery is contraindicated in the diabetic.
•The goal is to maintain the maternal glucose under control during the pregnancy. Fluctuation
can affect the fetus.
•The ideal maternal goal is glucose 65-95mg/dL before meals and no higher than 130- 140mg/dL one hour after meals. •A One-hour glucose screen at 28 weeks is performed on all pregnant women.
•Maternal risks include:
oMacrosomia
oHyperglycemia
oHypoglycemia
oMaternal ketoacidosis
•Placental complications
oPlacental deterioration and/or placental abruption
•Fetal risks include:
oHypoglycemia is most common complication for the newborn
oIntrauterine growth restriction
oUnexplained stillbirth
oCongenital anomalies
Substance abuse •Drug use, alcohol, smoking all can affect the fetus.
•Current standard of care for pregnant women addicted to opioids is Methadone maintenance program.
•Breastfeeding contraindicated in women who continue to use amphetamines, alcohol, cocaine, heroin or marijuana.
•Women who have certain drug levels in their system when arriving at hospital to deliver, may be
in jeopardy of losing custody of their newborn.
•Women using cocaine during pregnancy has a higher risk of a precipitous labor.
•A newborn addicted to drugs will develop tremors, be tachycardic and be hypertensive. If mother
tests positive for drugs on admission to labor and delivery, then the newborn needs to be tested using a meconium sample.
Cardiac & Liver transplants - should be advised to not get pregnant for 1-5 years following transplant.
Chronic hypertension •Clients with chronic hypertension will have an elevated blood pressure before the 20th week of
gestation and is at risk for fetal IUGR, preterm birth, placenta abruption and preeclampsia.
Gestational hypertension •Develops during pregnancy and is the most common medical complication reported during pregnancy. Gestational hypertension starts after 20 weeks gestation. The definition of high blood pressure is a systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.
Preeclampsia •GENERALIZED VASOSPASMS is the cause of preeclampsia (NOT high blood pressure). A diagnosis of preeclampsia can be made if there is protein present in the urine.
•Symptoms include:
oHypertension
oProteinuria can range from trace to 4+. Normal is negative.
oCentral nervous system irritability resulting in hyperactive deep tendon reflexes. May experience clonus.
oGeneralized edema including face (periorbital).
Daily kick counts •Fetal movement is a good sign of fetal well-being.
•Clients do not always feel the fetus movement; however, they should be able to feel at least 10 movements in any given 2-hour period.
•Client teaching should be done by the third trimester and needs to include instructions on how
to count movement and to notify the provider if they have no fetal movement for a period (like
12 hours).
•If fetal movement does not reach 10 movements in one hour, the client is instructed to drink a
few ounces of orange juice and monitor for another hour (total 2 hours).
•Remember, anything that depresses the mom’s CNS will also depress the fetal CNS.
Ultrasound •Ultrasound is a non-invasive procedure that is safe throughout the pregnancy. The test checks
different things in each of the 3 trimesters. Remember: 1st trimester is 1 through 13 weeks; 2nd
trimester is 14 through 26 weeks; and 3rd trimester is 27 through 40 weeks. Review your HESI
manual on page 251 to see what is assessed during each of the trimesters!
•One of the most common reasons for doing an ultrasound in the 2nd trimester (14-26 weeks) is
to assess if fetal growth matches the gestational age. Remember that all normal fetus grows the same up to 20 weeks because organs are being formed. Individual growth and weight vary after 20 weeks.
•Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they
should have an empty bladder.
•An ultrasound is an ideal test if the pregnant client is unsure of the date of her last menstrual period.
Biophysical Profile (BPP) •BPP is an accurate indicator of fetal well-being. Higher the score the better.
•There are five assessments done do determine a BPP score. Four ultrasound data includes fetal breathing, movement, heart rate, amniotic fluid index, and then the result of a non-
stress test.
Amniocentesis •An amniocentesis may be done for several reasons. It is an invasive procedure so there needs
to be a medical indication for one. The risk may be minimized by using ultrasound during the
procedure. If a client complains of low back pain with pelvic cramping following the procedure, it is imperative that they are assessed for complications from the procedure.
•RhoGam should be given following the procedure if the client is RH negative.
•If done for genetic concerns, remember that a high alphafetalprotein (AFP) may indicate a neural tubal defect; low may indicate trisomy 21
•Nursing consideration for an ultrasound: full bladder until 22 weeks, then after that, they
should have an empty bladder.
•Also used for assessing fetal lung maturity - L/S & S/A ratios 2:1 (see table 10-4) Maternal serum (MS) A.Alpha-fetoprotein (AFP) •Neural tube defects (NTD’s) •All pregnant women should receive testing.
•Folate taken preconceptionally and during early pregnancy has lowered the incidence of NTD.
•Alpha-fetoprotein is detected in mom’s serum from 14-34 weeks gestation.
B.Multiple marker screens for chromosomal abnormalities •Tested between 11-14 weeks gestation.
C.Coombs’ test for RH incompatibility •A coombs test is to determine if a Rh-negative mom has built antibodies against a Rh
positive fetus after delivery. If mom has a negative indirect coomb and her baby is Rh
positive, then she should receive RhoGam within 72 hours of delivery.
Non-Stress Test (NST) used antepartum •Purpose is to evaluate if fetus is receiving enough oxygen to respond to movement. This can
be a valuable test to assess fetal well-being in the high risk individuals.
•Interpretation criteria: FHR must increase with fetal movement for 15 seconds by 15 beats per
minute. Reactive = 2 acceleration in 20 minute period. Nonreactive = Heart rate did not respond adequately to fetal movement
Contraction Stress Test (CST) used antepartum •Purpose is to evaluate if fetus can tolerate the stress of contractions. Evaluation of fetal heart
rate response to contraction by looking for any pattern of fetal heart rate deceleration (Late decels) that indicate that the fetus does not have enough oxygen in reserve to make it completely through the contractions.
•Interpretation criteria: requires 3 contractions in 10 minutes.
oNegative ~ No late decels or variable decels noted ~ IDEAL results
oPositive ~ late decels are present with 50% or more contraction.
Diabetes mellitus (DM) •DM is a common risk factor in the childbearing age that automatically becomes a high risk pregnancy. There can be complications for mom as well as for the baby.
•It is important that the client is educated about the change in insulin requirements as a result
of the pregnancy. During the first trimester, maternal insulin needs decrease; during the second and third trimester, maternal insulin needs increase due to insulin resistance. After delivery, placental hormone levels drop abruptly, and insulin requirements decrease. It is important that the mom does not experience DKA because it can lead to fetal death! This client may require a cesarean section due to the risk of having a macrosomia fetus. Also, the diabetic client needs to be assessed closely for infection because it could lead to mom becoming hyperglycemic. The use of oral contraception after delivery is contraindicated in the diabetic.
•The goal is to maintain the maternal glucose under control during the pregnancy. Fluctuation
can affect the fetus.
•The ideal maternal goal is glucose 65-95mg/dL before meals and no higher than 130- 140mg/dL one hour after meals. •A One-hour glucose screen at 28 weeks is performed on all pregnant women.
•Maternal risks include:
oMacrosomia
oHyperglycemia
oHypoglycemia
oMaternal ketoacidosis
•Placental complications
oPlacental deterioration and/or placental abruption
•Fetal risks include:
oHypoglycemia is most common complication for the newborn
oIntrauterine growth restriction
oUnexplained stillbirth
oCongenital anomalies
Substance abuse •Drug use, alcohol, smoking all can affect the fetus.
•Current standard of care for pregnant women addicted to opioids is Methadone maintenance program.
•Breastfeeding contraindicated in women who continue to use amphetamines, alcohol, cocaine, heroin or marijuana.
•Women who have certain drug levels in their system when arriving at hospital to deliver, may be
in jeopardy of losing custody of their newborn.
•Women using cocaine during pregnancy has a higher risk of a precipitous labor.
•A newborn addicted to drugs will develop tremors, be tachycardic and be hypertensive. If mother
tests positive for drugs on admission to labor and delivery, then the newborn needs to be tested using a meconium sample.
Cardiac & Liver transplants - should be advised to not get pregnant for 1-5 years following transplant.
Chronic hypertension •Clients with chronic hypertension will have an elevated blood pressure before the 20th week of
gestation and is at risk for fetal IUGR, preterm birth, placenta abruption and preeclampsia.
Gestational hypertension •Develops during pregnancy and is the most common medical complication reported during pregnancy. Gestational hypertension starts after 20 weeks gestation. The definition of high blood pressure is a systolic BP greater than 140 mm Hg or diastolic BP greater than 90 mm Hg.
Preeclampsia •GENERALIZED VASOSPASMS is the cause of preeclampsia (NOT high blood pressure). A diagnosis of preeclampsia can be made if there is protein present in the urine.
•Symptoms include:
oHypertension
oProteinuria can range from trace to 4+. Normal is negative.
oCentral nervous system irritability resulting in hyperactive deep tendon reflexes. May experience clonus.
oGeneralized edema including face (periorbital).
