HESI COMPREHENSIVE REVIEW FOR NGN NCLEX-RN LATEST
2025/2026 ACTUAL EXAM WITH COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (100% VERIFIED ANSWERS)
|ALREADY GRADED A+| ||PROFESSOR VERIFIED|| ||BRANDNEW!!!||
A nurse developing a nursing care plan for a client with abruptio
placentae includes initial nursing measures to be implemented in
the event of the development of shock. After contacting the health
care provider, which does the nurse specify as the first action in
the event of shock? - ANSWER-Placing the client in a lateral
position with the bed flat
Rationale: If the client exhibits signs of hypovolemic shock,
the nurse would contact the health care provider. The nurse
would monitor fetal status closely and take action to
minimize the effects of hypovolemic shock and promote
tissue oxygenation. The client would be placed in a lateral
position, with the head of the bed flat to increase cardiac
return and thus increase circulation and oxygenation of the
placenta and other vital organs. After positioning the client,
the nurse would insert IV lines in accordance with the health
care provider's prescriptions and hospital protocols so that
blood and replacement fluids may be administered. Quick
preparation of the client for cesarean delivery may be
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necessary, but obtaining informed consent for the procedure
is not the first action. Urine output is monitored to ensure an
output of at least 30 mL/hr but, again, this is not the first
action.
A postpartum nurse provides information about normal and
abnormal characteristics of lochia to a client who has delivered a
healthy newborn. Which finding does the nurse tell the client to
report to the health care provider? - ANSWER-Reddish lochia on
postpartum day 8
Rationale: Lochia is the postdelivery vaginal discharge from
the uterus consisting of blood from the vessels of the
placental site and debris from the deciduas. Rubra is the
bright-red lochial discharge that appears from delivery day to
day 3. Serosa is the brownish-pink lochial discharge that
appears on days 4 to 10. Alba is the white lochial discharge
that appears on days 10 to 14. Reddish lochia on postpartum
day 8 is an abnormal finding and would be reported to the
health care provider.
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A nurse in a health care provider's office is conducting a 2-week
postpartum assessment of a client. During abdominal
assessment, the nurse is unable to palpate the uterine fundus.
This finding would prompt the nurse to: - ANSWER-Document the
findings
Rationale: Involution is the progressive descent of the uterus
into the pelvic cavity after delivery. Twenty-four hours after
birth, descent of the fundus begins at a rate of approximately
1 fingerbreadth, or approximately 1 cm, per day. By the 10th
to 14th day, the fundus is in the pelvic cavity and cannot be
palpated abdominally. Asking the health care provider to see
the client immediately, having another nurse check for the
uterine fundus, and placing the client in the supine position
for 5 minutes and rechecking the abdomen are all incorrect
and unnecessary actions in light of the assessment finding.
A maternity nurse providing an education session to a group of
expectant mothers describes the purpose of the placenta. Which
statement by one of the women attending the session indicates a
need for further discussion of the purpose of the placenta? -
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ANSWER-"The placenta maintains the body temperature of my
baby."
Rationale: Many of the immunoglobulin G (IgG) class of
antibodies are passed from mother to fetus through the
placenta. Glucose, fatty acids, vitamins, and electrolytes
pass readily across the placenta; glucose is the major source
of energy for fetal growth and metabolic activities. The
placenta provides an exchange of nutrients and waste
products between the mother and fetus. Oxygen and carbon
dioxide pass through the placental membrane by way of
simple diffusion. The amniotic fluid surrounds, cushions,
and protects the fetus and maintains the body temperature of
the fetus.
A client arrives at the clinic for her first prenatal assessment. The
client tells the nurse that the first day of her last menstrual period
(LMP) was September 25, 2017. Using Nagele's rule, the nurse
determines that the estimated date of delivery (EDD) is: -
ANSWER-July 2, 2018