OB HESI PRACTICE TEST

1. While breastfeeding, a new mother strokes the top of her baby's head and asks the nurse about the baby's swollen scalp. The nurse responds that the swelling is caput succedaneum. Which additional information should the nurse provide this new mother? A) The infant should be positioned to reduce the swelling. Feedback: INCORRECT B) The swelling is a subperiosteal collection of blood. Feedback: INCORRECT C) The pediatrician will aspirate the blood if it gets larger. Feedback: INCORRECT D) The scalp edema will subside in a few days after birth. Feedback: CORRECT Feedback: Caput succedaneum is edema of the fetal scalp that crosses over the suture lines and is caused by pressure on the fetal head against the cervix during labor; it subside in a few days after birth without treatment. Cephalohematoma, a subperiosteal collection of blood that does not cross the suture lines and is a common benign birth injury. 2. A client at 30-weeks gestation, complaining of pressure over the pubic area, is admitted for observation. She is contracting irregularly and demonstrates underlying uterine irritability. Vaginal examination reveals that her cervix is closed, thick, and high. Based on these data, which intervention should the nurse implement first? A) Provide oral hydration. Feedback: INCORRECT B) Have a complete blood count (CBC) drawn. Feedback: INCORRECT C) Obtain a specimen for urine analysis. Feedback: CORRECT D) Place the client on strict bedrest. Feedback: INCORRECT Feedback: Obtaining a urine analysis (C) should be done first because preterm clients with uterine irritability and contractions are often suffering from a urinary tract infection, and this should be ruled out first. 3. A newborn, whose mother is HIV positive, is scheduled for follow-up assessments. The nurse knows that the most likely presenting symptom for a pediatric client with AIDS is: A) Shortness of breath. Feedback: INCORRECT B) Joint pain. Feedback: INCORRECT C) A persistent cold. Feedback: CORRECT D) organomegaly. Feedback: INCORRECT Feedback: Respiratory tract infections commonly occur in the pediatric population. However, the child with AIDS has a decreased ability to defend the body against these infections and often the presenting symptom of a child with AIDS is a persistent cold (C). 4. A client who has an autosomal dominant inherited disorder is exploring family planning options and the risk of transmission of the disorder to an infant. The nurse's response should be based on what information? A) Males inherit the disorder with a greater frequency than females. Feedback: INCORRECT B) Each pregnancy carries a 50% chance of inheriting the disorder. Feedback: CORRECT C) The disorder occurs in 25% of pregnancies. Feedback: INCORRECT D) All children will be carriers of the disorder. Feedback: INCORRECT Feedback: According to the laws of inheritance, an autosomal dominant disorder has a 50% chance of being transmitted with each pregnancy (B), and if transmitted, the disorder will appear in the child. 5. 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. Feedback: INCORRECT B) Her arms and hands receive the infant and she then traces the infant's profile with her fingertips. Feedback: CORRECT C) Her arms and hands receive the infant and she then cuddles the infant to her own body. Feedback: INCORRECT D) She eagerly reaches for the infant and then holds the infant close to her own body. Feedback: INCORRECT Feedback: Attachment/bonding theory indicates that most mothers will demonstrate behaviors described in (B) during the first visit with the newborn, which may be at delivery or later. After the first visit, the mother may exhibit greater affection such as eagerly reaching, hugging, etc. (A, C, and D). 6. A pregnant client tells the nurse that the first day of her last menstrual period was August 2, 2006. Based on Nägele’s rule, what is the estimated date of delivery? A) April 25, 2007. Feedback: INCORRECT B) May 9, 2007. Feedback: CORRECT C) May 29, 2007. Feedback: INCORRECT D) June 2, 2007. Feedback: INCORRECT Feedback: INCORRECT Since this woman's first day of her last normal menstrual period occurred on August 2, 2006, the estimated date of delivery is May 9, 2007 (B). Nägele’s rule is used to calculate the expected date of delivery, and is obtained by subtracting 3 months and adding 7 days beginning from the first day of the last normal menstrual period. 7. A woman who gave birth 48 hours ago is bottle-feeding her infant. During assessment, the nurse determines that both breasts are swollen, warm, and tender upon palpation. What action should the nurse take? A) Apply cold compresses to both breasts for comfort. Feedback: CORRECT B) Instruct the client run warm water on her breasts. Feedback: INCORRECT C) Wear a loose-fitting bra to prevent nipple irritation. Feedback: INCORRECT D) Express small amounts of milk to relieve pressure. Feedback: INCORRECT Feedback: The client is experiencing engorgement even though she is bottle-feeding her infant, and cold compresses (A) may help reduce discomfort. Lactation begins about the third day after delivery, so the mother should avoid any breast stimulation, such as (B or D), which further stimulates milk production. 8. A woman who had a miscarriage 6 months ago becomes pregnant. Which instruction is most important for the nurse to provide this client? A) Elevate lower legs while resting. Feedback: INCORRECT B) Increase caloric intake by 200 to 300 calories per day. Feedback: INCORRECT C) Increase water intake to 8 full glasses per day. Feedback: INCORRECT D) Take prescribed multivitamin and mineral supplements. Feedback: CORRECT Feedback: A client who has had a spontaneous abortion or still birth in the last 1½ years should take multivitamin and mineral supplements (D) and maintain a balanced diet because the previous pregnancy may have left her nutritionally depleted 9. Which action should the nurse implement when preparing to measure the fundal height of a pregnant client? A) Have the client empty her bladder. Feedback: CORRECT B) Request the client lie on her left side. Feedback: INCORRECT C) Perform Leopold’s maneuvers first. Feedback: INCORRECT D) Give the client some cold juice to drink. Feedback: INCORRECT Feedback: To accurately measure the fundal height, the bladder must be empty (A) to avoid elevation of the uterus. 10. The total bilirubin level of a 36-hour, breastfeeding newborn is 14 mg/dl. Based on this finding, which intervention should the nurse implement? A) Provide phototherapy for 30 minutes q8h. Feedback: INCORRECT B) Feed the newborn sterile water hourly. Feedback: INCORRECT C) Encourage the mother to breastfeed frequently. Feedback: CORRECT D) Assess the newborn's blood glucose level. Feedback: INCORRECT Feedback: The normal total bilirubin level is 6 to 12 mg/dl after Day 1 of life. This infant's bilirubin is beginning to climb and the infant should be monitored to prevent further complications. Breast milk provides calories and enhances GI motility, which will assist the bowel in eliminating bilirubin (C). 11. In evaluating the respiratory effort of a one-hour-old infant using the Silverman-Anderson Index, the nurse determines the infant has synchronized chest and abdominal movement, just visible lower chest retractions, just visible xiphoid retractions, minimal and transient nasal flaring, and an expiratory grunt heard only on auscultation. What Silverman-Anderson score should the nurse assign to this infant? (Enter numeral value only.) Feedback: A Silverman-Anderson Index has five categories with scores of 0, 1, or 2. the total score ranges from 0 to 10. Four of these assessment findings should receive a score of 1, and the 5th finding (synchronized chest and abdominal movement) receives a score of 0. Therefore, the total score is 4. A total score of 0 means the infant has no dyspnea, a total score of 10 indicates maximum respiratory distress. 12. A vaginally delivered infant of an HIV positive mother is admitted to the newborn nursery. What intervention should the nurse perform first? A) Bathe the infant with an antimicrobial soap. Feedback: CORRECT B) Measure the head and chest circumference. Feedback: INCORRECT C) Obtain the infant's footprints. Feedback: INCORRECT D) Administer vitamin K (AquaMEPHYTON). Feedback: INCORRECT Feedback: To reduce direct contact with the human immuno-virus in blood and body fluids on the newborn's skin, a bath (A) with an antimicrobial soap should be administered first. 13. 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 A) anterior fontanel closes at 2 to 4 months and the posterior by the end of the first week. Feedback: INCORRECT B) anterior fontanel closes at 5 to 7 months and the posterior by the end of the second week. Feedback: INCORRECT C) anterior fontanel closes at 8 to 11 months and the posterior by the end of the first month. Feedback: INCORRECT D) Anterior fontanel closes at 12 to 18 months and the posterior by the end of the second month. Feedback: CORRECT Feedback: 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 (D). 14. The nurse should explain to a 30-year-old gravid client that alpha fetoprotein testing is recommended for which purpose? A) Detect cardiovascular disorders. Feedback: INCORRECT B) Screen for neural tube defects. Feedback: CORRECT C) Monitor the placental functioning. Feedback: INCORRECT D) Assess for maternal pre-eclampsia. Feedback: INCORRECT Feedback: Alpha-fetoprotein (AFP) is a screening test used in pregnancy. Elevated AFP may indicate an increased rish of neural tube defects (B) such as anencephaly and spinal bifida. 15. The nurse is assessing a client who is having a non-stress test (NST) at 41-weeks gestation. The nurse determines that the client is not having contractions, the fetal heart rate (FHR) baseline is 144 bpm, and no FHR accelerations are occurring. What action should the nurse take? A) Check the client for urinary bladder distention. Feedback: INCORRECT B) Notify the healthcare provider of the nonreactive results. Feedback: INCORRECT C) Have the mother stimulate the fetus to move. Feedback: INCORRECT D) Ask the client if she has felt any fetal movement. Feedback: CORRECT Feedback: The client should be asked if she has felt the fetus move (D). An NST is used to determine fetal well-being, and is often implemented when postmaturity is suspected. A "reactive" NST occurs if the FHR accelerates 15 bpm for 15 seconds in response to the fetus' own movement, and is "nonreactive" if no FHR acceleration occurs in response to fetal movement. The client should empty her bladder before starting the test, but bladder distention does not impede fetal movement (A). The client should be quizzed about fetal movement before determining that the NST is nonreactive (B). If no movement has occurred in the last 20 to 30 minutes, it is likely that the fetus is sleeping--providing the mother with orange juice often wakes the infant, and then the NST should be conducted again. 16. A new mother is afraid to touch her baby's head for fear of hurting the "large soft spot." Which explanation should the nurse give to this anxious client? A) Some care