HESI NCLEX-RN COMPREHENSIVE
REVIEW (MATERNITY) EXAM
QUESTIONS & CORRECT SOLUTIONS
ALL PASSED GRADED A+
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?
A. Two weeks before menstruation
B. Immediately after menstruation
C. Immediately before menstruation
D. Three weeks before menstruation - correct answer ✔✔A
Rationale:
Ovulation occurs 14 days before the first day of the menstrual period. Although 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 the menstrual cycle varies.
Options B, C, and D are incorrect.
A new mother asks the nurse, "How do I know that my daughter is getting enough breast milk?"
Which explanation is appropriate?
A. "Weigh the baby daily, and if she is gaining weight, she is getting enough to eat."
B. "Your milk is sufficient if the baby is voiding pale, straw-colored urine six to ten times a day."
C. "Offer the baby extra bottled milk after her feeding and see if she still seems hungry."
D. "If you're concerned, you might consider bottle feeding so that you can monitor intake." -
correct answer ✔✔B
Rationale:
,The urine will be dilute (straw-colored) and frequent (>6 to 10 times/day), if the infant is
adequately hydrated. Although a weight gain of 30 g/day is indicative of adequate nutrition,
most home scales do not measure this accurately, and the suggestion will likely make the
mother anxious. Option C causes nipple confusion and diminishes the mother's milk production.
Option D does not address the client's question.
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. Which of the
following should be the focus of the nurse's response?
A. Telling the client and her partner that the labor process is often unpredictable
B. Informing the client that this means she will give birth sooner than expected
C. Asking the client and her partner if they would like the nurse to stay in the room
D. Affirming that the fetal heart rate is remaining within normal limits - correct answer ✔✔C
Rationale:
Offering to remain with the client and her partner offers support without providing false
reassurance. The length of labor is not always predictable, but options A and B do not offer the
client the support that is needed at this time. Option D may be reassuring regarding the fetal
heart rate but does not provide the client the emotional support she needs at this time during
the labor process.
A newborn infant, diagnosed with developmental dysplasia of the hip (DDH), is being prepared
for discharge. Which nursing intervention should be included in this infant's discharge teaching
plan?
A. Observe the parents applying a Pavlik harness.
B. Provide a referral for an orthopedic surgeon.
C. Schedule a physical therapy follow-up home visit.
D. Teach the parents to check for hip joint mobility. - correct answer ✔✔A
Rationale:
, It is important that the hips of infants with hip dysplasia are maintained in an abducted position,
which can be accomplished by using the Pavlik harness; this keeps the hips and knees flexed,
the hips abducted, and the femoral head in the acetabulum. Early treatment often negates the
need for surgery, and option B is not indicated until approximately 6 months of age. Option C is
not indicated for hip dysplasia. It is best for the pediatrician to monitor hip joint mobility, and
teaching the parents to perform this technique is likely to increase their anxiety.
Which maternal behavior is the nurse most likely to see when a new mother receives her infant
for the first time?
A. She eagerly reaches for the infant, undresses the infant, and examines the infant completely.
B. Her arms and hands receive the infant and she then traces the infant's profile with her
fingertips.
C. Her arms and hands receive the infant and she then cuddles the infant to her own body.
D. She eagerly reaches for the infant and then holds the infant close to her own body. - correct
answer ✔✔B
Rationale:
Attachment and bonding theory indicates that most mothers will demonstrate behaviors
described in option B during the first visit with the newborn, which may be at delivery or later.
After the first visit, the mother may exhibit different touching behaviors such as eagerly
reaching for the infant and cuddling the infant close to her.
A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is
prescribed. Which instruction should the nurse provide to this client?
A. Breastfeed the infant, ensuring that both breasts are completely emptied.
B. Feed expressed breast milk to avoid the pain of the infant latching onto the infected breast.
C. Breastfeed on the unaffected breast only until the mastitis subsides.
D. Dilute expressed breast milk with sterile water to reduce the antibiotic effect on the infant. -
correct answer ✔✔A
REVIEW (MATERNITY) EXAM
QUESTIONS & CORRECT SOLUTIONS
ALL PASSED GRADED A+
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?
A. Two weeks before menstruation
B. Immediately after menstruation
C. Immediately before menstruation
D. Three weeks before menstruation - correct answer ✔✔A
Rationale:
Ovulation occurs 14 days before the first day of the menstrual period. Although 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 the menstrual cycle varies.
Options B, C, and D are incorrect.
A new mother asks the nurse, "How do I know that my daughter is getting enough breast milk?"
Which explanation is appropriate?
A. "Weigh the baby daily, and if she is gaining weight, she is getting enough to eat."
B. "Your milk is sufficient if the baby is voiding pale, straw-colored urine six to ten times a day."
C. "Offer the baby extra bottled milk after her feeding and see if she still seems hungry."
D. "If you're concerned, you might consider bottle feeding so that you can monitor intake." -
correct answer ✔✔B
Rationale:
,The urine will be dilute (straw-colored) and frequent (>6 to 10 times/day), if the infant is
adequately hydrated. Although a weight gain of 30 g/day is indicative of adequate nutrition,
most home scales do not measure this accurately, and the suggestion will likely make the
mother anxious. Option C causes nipple confusion and diminishes the mother's milk production.
Option D does not address the client's question.
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. Which of the
following should be the focus of the nurse's response?
A. Telling the client and her partner that the labor process is often unpredictable
B. Informing the client that this means she will give birth sooner than expected
C. Asking the client and her partner if they would like the nurse to stay in the room
D. Affirming that the fetal heart rate is remaining within normal limits - correct answer ✔✔C
Rationale:
Offering to remain with the client and her partner offers support without providing false
reassurance. The length of labor is not always predictable, but options A and B do not offer the
client the support that is needed at this time. Option D may be reassuring regarding the fetal
heart rate but does not provide the client the emotional support she needs at this time during
the labor process.
A newborn infant, diagnosed with developmental dysplasia of the hip (DDH), is being prepared
for discharge. Which nursing intervention should be included in this infant's discharge teaching
plan?
A. Observe the parents applying a Pavlik harness.
B. Provide a referral for an orthopedic surgeon.
C. Schedule a physical therapy follow-up home visit.
D. Teach the parents to check for hip joint mobility. - correct answer ✔✔A
Rationale:
, It is important that the hips of infants with hip dysplasia are maintained in an abducted position,
which can be accomplished by using the Pavlik harness; this keeps the hips and knees flexed,
the hips abducted, and the femoral head in the acetabulum. Early treatment often negates the
need for surgery, and option B is not indicated until approximately 6 months of age. Option C is
not indicated for hip dysplasia. It is best for the pediatrician to monitor hip joint mobility, and
teaching the parents to perform this technique is likely to increase their anxiety.
Which maternal behavior is the nurse most likely to see when a new mother receives her infant
for the first time?
A. She eagerly reaches for the infant, undresses the infant, and examines the infant completely.
B. Her arms and hands receive the infant and she then traces the infant's profile with her
fingertips.
C. Her arms and hands receive the infant and she then cuddles the infant to her own body.
D. She eagerly reaches for the infant and then holds the infant close to her own body. - correct
answer ✔✔B
Rationale:
Attachment and bonding theory indicates that most mothers will demonstrate behaviors
described in option B during the first visit with the newborn, which may be at delivery or later.
After the first visit, the mother may exhibit different touching behaviors such as eagerly
reaching for the infant and cuddling the infant close to her.
A breastfeeding postpartum client is diagnosed with mastitis, and antibiotic therapy is
prescribed. Which instruction should the nurse provide to this client?
A. Breastfeed the infant, ensuring that both breasts are completely emptied.
B. Feed expressed breast milk to avoid the pain of the infant latching onto the infected breast.
C. Breastfeed on the unaffected breast only until the mastitis subsides.
D. Dilute expressed breast milk with sterile water to reduce the antibiotic effect on the infant. -
correct answer ✔✔A
