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RN HESI Maternity Exam Questions With 100% Pass

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RN HESI Maternity Exam Questions With 100% Pass /. A primigravida arrives at the observation unit of the maternity unit because thinks is in labor. The nurse applies the external fetal heart monitor and determines that the fetal heart rate is 140 beats/minute and the contractions are occurring irregularly every 10 to 15 minutes. What assessment finding confirms to the nurse that the client is not labor at this time? - Answer-Contractions decrease with walking. /.A primipara has delivered a stillborn fetus at 30 weeks gestation. To asses the parents in the grieving process which intervention is most for the nurse to implement ? A. explain the possible cause of the fetal demise B. Provide a time for the parents to hold their infant in privacy C. Encourage the parents to seek counseling within the next few weeks D. Assist the couple to request autopsy - Answer-B. provide a time for the parents to hold their infant in privacy /.What is the priority nursing assessment immediately following the birth of an infant with esophageal atresia and a tracheoesophageal (the) fistula ? A. body temperature B. level of pain C. time of first void D. number of vessels in the cord - Answer-A. body temperature /.What is the most important assessment for the nurse to conduct following the administration of epidural anesthesia to a client who is at 40-weeks gestation? A. Level of pain sensation B. Station of presenting part C. Variability of fetal heart rate D. Maternal blood pressure - Answer-D. Maternal blood pressure /.A 34-week primigravida with pregnancy induced hypertension (PIH) is receiving Ringer's Lactate 500 ml with magnesium sulfate 20 grams at the rate of 3 grams/hour. How many ml/hour should the nurse program the infusion pump? (Enter numeric value only) A. 120 B. 70 C. 65 D. 75 - Answer-D. 75 /.A mother of a 3-year-old boy has just given birth to a new baby girl. The little boy asks the nurse, "Why is my baby sister eating my mommy's breast?" How should the nurse respond? (Select all that apply) A. Explain that newborns get milk from their mothers in this way B. Reassure the older brother that it does not hurt his mother C. Remind him that his mother breastfed him too D. Suggest that the baby can also drink from a bottle E. Clarify that breastfeeding is his mother's choice - Answer-A. Explain that newborns get milk from their mothers in this way B. Reassure the older brother that it does not hurt his mother C. Remind him that his mother breastfed him too /.The nurse is examining an infant for possible cryptorchidism. Which exam technique should be used? A. Place the infant in side-lying to facilitate the exam B. Hold the penis and retract the foreskin gently C. Cleanse the penis with an antiseptic-soaked pad D. Place the infant in warm room and use a calm approach - Answer-D. Place the infant in warm room and use a calm approach /.The nurse is planning care for a client at 30-weeks gestation who is experiencing preterm labor. What maternal prescription is most important in preventing this fetus from developing respiratory distress syndrome? A. Betamethasone (Celestone) 12 mg deep IM B. Butorphanol 1 mg IV push q2h PRN pain C. Ampicillin 1 Gram IV push q8h D. Terbutaline (Brethine) 0.25 mg subcutaneously q15 minutes x3 - Answer-A. Betamethasone (Celestone) 12 mg deep IM /.A 3-month-old with myelomeningocele and atonic bladder is catheterized every 4 hours to prevent urinary retention. The home health nurse notes that the child has developed episodes of sneezing, urticaria, watery eyes, and a rash in the diaper area. What action is most important for the nurse to take? A. Auscultate the lungs for respiratory pneumonia. B. Draw blood to analyze for streptococcal infection C. Change to latex-free gloves when handling infant D. Apply zinc oxide to perineum with each diaper change - Answer-C. Change to latex-free gloves when handling infant /.The nurse is caring for a female client, a primigravida, with preeclampsia. Findings include +2 proteinuria, BP 172/112 mmHg, facial and hand swelling, complaints of blurry vision and a severe frontal headache. Which medication should the nurse anticipate for this client? A. Clonidine hydrochloride B. Carbamazepine C. Furosemide D. Magnesium sulfate - Answer-D. Magnesium sulfate /.A client at 35-weeks gestation complains of a "pain whenever the baby moves." On assessment, the nurse notes the client's temperature to be 101.2F, with severe abdominal or uterine tenderness on palpation. The nurse knows that these findings are indicative of what condition? A. Round ligament strain B. Chorioamnionitis C. Abruptio placenta D. Viral infection. - Answer-B. Chorioamnionitis /.A male infant with a 2-day history of fever and diarrhea is brought to a clinic by his mother who tells the nurse that the child refuses to drink anything. The nurse determines that the child has a weak cry with no tears. Which prescription is most important to implement? A. Provide a bottle of electrolyte solution B. Infuse normal saline intravenously C. Administer an antipyretic rectally D. Apply external cooling blanket - Answer-B. Infuse normal saline intravenously /.A 6-month old child who had a cleft-lip repair has elbow restraints in place. What nursing intervention should the nurse plan to implement? A. remove restraints q4h for 30 minutes and place gloves on the child's hands B. record observations of the restraints q2h and ensure that they are in place at all times C. obtain the HCP advice as to when the restraints should be removed D. remove restraints one at a time to provide ROM exercises - Answer-D. remove restraints one at a time to provide ROM exercises /.A new mother calls the nurse stating that she wants to start feeding her 6-month-old child something besides breast milk, but is concerned that the infant is too young to start eating solid foods. How should the nurse respond? A. encourage the mother to schedule a developmental assessment of the infant B. advise the mother to wait at least another month before starting any solid foods C. instruct the mother to offer a few spoons of 2-3 pureed fruit at each meal D. reassure the mother that the infant is old enough to eat iron-fortified cereal - Answer-D. reassure the mother that the infant is old enough to eat iron-fortified cereal /.While caring for a laboring client on continuous fetal monitoring, the nurse notes a fetal heart rate pattern that falls and rises abruptly with a "V" shaped appearance. What action should the nurse take first? A. Prepare for a potential cesarean B. Allow the client to begin pushing C. Administer oxygen at 10/L by mask D. Change the maternal position - Answer-D. Change the maternal position /.A postpartum client who is Rh-negative refuses to receive Rho (D) immune globulin (RhoGam) after delivery of an infant who is Rh-positive. Which information should the nure provide this client? A. RhoGam is not necessary unless all her pregnancies are Rh-positive B. The R-positive factor from the fetus threatens her blood cells C. The mother should receive RhoGam when the baby is Rh-negative D. RhoGam prevents maternal antibody formation for future Rh-positive babies - Answer-D. RhoGam prevents maternal antibody formation for future Rh-positive babies /.A 6-week-old infant diagnosed with pyloric stenosis has recently developed projectile vomiting. Which assessment finding indicates to the nurse that the infant is becoming dehydrated? A. Weak cry without any tears B. Bulging fontanel C. Visible peristaltic wave. D. Palpable mass in the right upper quadrant - Answer-A. Weak cry without any tears /.A full-term, 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. What should the nurse do first? A. Suction the oral and nasal passages B. Give oxygen by positive pressure C. Stimulate the infant to cry D. Turn the infant onto the right side - Answer-C. Stimulate the infant to cry /.A client at 40-weeks' gestation presents to the obstetrical floor and indicates that the amniotic membranes ruptured spontaneously at home. She is in active labor and feels the need to bear down and push. What information is most important for the nurse to obtain first? A. the estimated amount of fluid B. time the membranes ruptured C. color and consistency of the fluid D. any odor noted when membranes ruptured. - Answer-C. color and consistency of the fluid /.An infant with tetralogy of Fallot becomes acutely cyanotic and hyper apneic. Which action should the nurse implement first?A. Administer morphine sulphate. B. Start IV fluids. C. Place the infant in a knee-chest position D. Provide 100% oxygen by face mask. - Answer-C. Place the infant in a knee-chest position

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RN HESI Maternity Exam Questions
With 100% Pass

/. A primigravida arrives at the observation unit of the maternity unit because thinks is in
labor. The
nurse applies the external fetal heart monitor and determines that the fetal heart rate is
140
beats/minute and the contractions are occurring irregularly every 10 to 15 minutes.
What
assessment finding confirms to the nurse that the client is not labor at this time? -
Answer-Contractions decrease with walking.

/.A primipara has delivered a stillborn fetus at 30 weeks gestation. To asses the parents
in the grieving process which intervention is most for the nurse to implement ?
A. explain the possible cause of the fetal demise
B. Provide a time for the parents to hold their infant in privacy
C. Encourage the parents to seek counseling within the next few weeks
D. Assist the couple to request autopsy - Answer-B. provide a time for the parents to
hold their infant in privacy

/.What is the priority nursing assessment immediately following the birth of an infant with
esophageal atresia and a tracheoesophageal (the) fistula ?

A. body temperature
B. level of pain
C. time of first void
D. number of vessels in the cord - Answer-A. body temperature

/.What is the most important assessment for the nurse to conduct following the
administration of epidural anesthesia to a client who is at 40-weeks gestation?
A. Level of pain sensation
B. Station of presenting part
C. Variability of fetal heart rate
D. Maternal blood pressure - Answer-D. Maternal blood pressure

/.A 34-week primigravida with pregnancy induced hypertension (PIH) is receiving
Ringer's Lactate 500 ml with magnesium sulfate 20 grams at the rate of 3 grams/hour.
How many ml/hour should the nurse program the infusion pump? (Enter numeric value
only)
A. 120
B. 70
C. 65

,D. 75 - Answer-D. 75

/.A mother of a 3-year-old boy has just given birth to a new baby girl. The little boy asks
the nurse, "Why is my baby sister eating my mommy's breast?" How should the nurse
respond? (Select all that apply)
A. Explain that newborns get milk from their mothers in this way
B. Reassure the older brother that it does not hurt his mother
C. Remind him that his mother breastfed him too
D. Suggest that the baby can also drink from a bottle
E. Clarify that breastfeeding is his mother's choice - Answer-A. Explain that newborns
get milk from their mothers in this way
B. Reassure the older brother that it does not hurt his mother
C. Remind him that his mother breastfed him too

/.The nurse is examining an infant for possible cryptorchidism. Which exam technique
should be used?
A. Place the infant in side-lying to facilitate the exam
B. Hold the penis and retract the foreskin gently
C. Cleanse the penis with an antiseptic-soaked pad
D. Place the infant in warm room and use a calm approach - Answer-D. Place the infant
in warm room and use a calm approach

/.The nurse is planning care for a client at 30-weeks gestation who is experiencing
preterm labor. What maternal prescription is most important in preventing this fetus from
developing respiratory distress syndrome?
A. Betamethasone (Celestone) 12 mg deep IM
B. Butorphanol 1 mg IV push q2h PRN pain
C. Ampicillin 1 Gram IV push q8h
D. Terbutaline (Brethine) 0.25 mg subcutaneously q15 minutes x3 - Answer-A.
Betamethasone (Celestone) 12 mg deep IM

/.A 3-month-old with myelomeningocele and atonic bladder is catheterized every 4
hours to prevent urinary retention. The home health nurse notes that the child has
developed episodes of sneezing, urticaria, watery eyes, and a rash in the diaper area.
What action is most important for the nurse to take?
A. Auscultate the lungs for respiratory pneumonia.
B. Draw blood to analyze for streptococcal infection
C. Change to latex-free gloves when handling infant
D. Apply zinc oxide to perineum with each diaper change - Answer-C. Change to latex-
free gloves when handling infant

/.The nurse is caring for a female client, a primigravida, with preeclampsia. Findings
include +2 proteinuria, BP 172/112 mmHg, facial and hand swelling, complaints of blurry
vision and a severe frontal headache. Which medication should the nurse anticipate for
this client?
A. Clonidine hydrochloride

, B. Carbamazepine
C. Furosemide
D. Magnesium sulfate - Answer-D. Magnesium sulfate

/.A client at 35-weeks gestation complains of a "pain whenever the baby moves." On
assessment, the nurse notes the client's temperature to be 101.2F, with severe
abdominal or uterine tenderness on palpation. The nurse knows that these findings are
indicative of what condition?
A. Round ligament strain
B. Chorioamnionitis
C. Abruptio placenta
D. Viral infection. - Answer-B. Chorioamnionitis

/.A male infant with a 2-day history of fever and diarrhea is brought to a clinic by his
mother who tells the nurse that the child refuses to drink anything. The nurse
determines that the child has a weak cry with no tears. Which prescription is most
important to implement?

A. Provide a bottle of electrolyte solution
B. Infuse normal saline intravenously
C. Administer an antipyretic rectally
D. Apply external cooling blanket - Answer-B. Infuse normal saline intravenously

/.A 6-month old child who had a cleft-lip repair has elbow restraints in place. What
nursing intervention should the nurse plan to implement?

A. remove restraints q4h for 30 minutes and place gloves on the child's hands
B. record observations of the restraints q2h and ensure that they are in place at all
times
C. obtain the HCP advice as to when the restraints should be removed
D. remove restraints one at a time to provide ROM exercises - Answer-D. remove
restraints one at a time to provide ROM exercises

/.A new mother calls the nurse stating that she wants to start feeding her 6-month-old
child something besides breast milk, but is concerned that the infant is too young to
start eating solid foods. How should the nurse respond?

A. encourage the mother to schedule a developmental assessment of the infant
B. advise the mother to wait at least another month before starting any solid foods
C. instruct the mother to offer a few spoons of 2-3 pureed fruit at each meal
D. reassure the mother that the infant is old enough to eat iron-fortified cereal - Answer-
D. reassure the mother that the infant is old enough to eat iron-fortified cereal

/.While caring for a laboring client on continuous fetal monitoring, the nurse notes a fetal
heart rate pattern that falls and rises abruptly with a "V" shaped appearance. What
action should the nurse take first?
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