HESI RN
HESI Maternity Test Bank
1. The healthcare provider prescribes magnesium sulfate 6 grams intravenously (IV) to be infused over 20 minutes for a client with preterm labor. The IV bag contains magnesium sulfate 20 grams in dextrose 5% in water 500 mL. How many mL/hour should the nurse set the infusion pump?
- A. 150 mL/hour
- B. 250 mL/hour
- C. 50 mL/hour
- D. 275 mL/hour
Correct answer: A
Rationale: To calculate the infusion rate, first, determine the total volume to be infused (6 grams of magnesium sulfate) over a specific time frame (20 minutes). Then, calculate the concentration of magnesium sulfate in the IV bag to determine the mL/hour rate. The IV bag contains 20 grams of magnesium sulfate in 500 mL of solution, which means there are 4 grams of magnesium sulfate per 100 mL. Since 6 grams are required, the nurse should set the pump to deliver 150 mL/hour to infuse the prescribed dose over 20 minutes. Choice B, 250 mL/hour, is incorrect because it miscalculates the amount of magnesium sulfate infused per hour. Choice C, 50 mL/hour, is incorrect as it is too slow to deliver the required dose in the specified time frame. Choice D, 275 mL/hour, is incorrect as it overestimates the infusion rate and would deliver the dose too quickly.
2. What maternal behavior is typically observed when a new mother first receives her infant?
- 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: When a new mother first receives her infant, a typical maternal behavior is to use her arms and hands to receive the infant and then trace the infant's profile with her fingertips. This action is a gentle way of bonding with the newborn and aids in recognizing the infant's features. Choices A, C, and D are incorrect as they do not accurately describe the common behavior of tracing the infant's profile, which is a significant part of the initial interaction between a mother and her newborn.
3. When can a woman who thinks she may be pregnant use a home pregnancy test to diagnose pregnancy?
- A. A home pregnancy test can be used right after your first missed period.
- B. These tests are most accurate after you have missed your second period.
- C. Home pregnancy tests often give false positives and should not be trusted.
- D. The test can provide accurate information when used right after ovulation.
Correct answer: A
Rationale: The correct answer is A. Home pregnancy tests detect hCG, a hormone produced during pregnancy, and are most accurate after the first missed period when hCG levels are higher. Testing too early may result in a false negative. Waiting until after the first missed period increases the reliability of the test results. Choice B is incorrect as waiting until after the second missed period is unnecessary and may delay seeking appropriate healthcare. Choice C is incorrect as home pregnancy tests are generally reliable when used correctly. Choice D is incorrect because ovulation occurs before the period, and testing immediately after ovulation may not provide accurate results.
4. 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. Advise the mother to wait at least another month before starting any solid foods.
- B. Instruct the mother to offer a few spoons of 2 or 3 pureed fruits at each meal.
- C. Reassure the mother that the infant is old enough to eat iron-fortified cereal.
- D. Encourage the mother to schedule a developmental assessment of the infant.
Correct answer: C
Rationale: At 6 months, infants are generally ready to start eating iron-fortified cereals as their iron stores begin to deplete. Introducing iron-fortified cereals at this age helps meet the infant's nutritional needs, particularly for iron, which becomes deficient as the infant's iron reserves diminish. It is a safe and appropriate first food to introduce to infants around 6 months of age, along with continued breastfeeding or formula feeding. Choice A is incorrect because waiting another month is not necessary if the infant is 6 months old. Choice B is incorrect as introducing pureed fruits as the first food may not provide the necessary iron that the infant needs at this stage. Choice D is also incorrect as scheduling a developmental assessment is not indicated solely based on the desire to start solid foods; it is more appropriate to reassure the mother about starting iron-fortified cereal.
5. When preparing a class on newborn care for expectant parents, what content should be taught concerning the newborn infant born at term gestation?
- A. Milia are white marks caused by sebaceous glands and typically resolve within 2 to 4 weeks.
- B. Meconium is the first stool and is typically dark green or black in color.
- C. Vernix caseosa is a white, cheesy substance mainly found in skin folds, providing a protective layer.
- D. Pseudostrabismus in newborns usually self-resolves without the need for intervention.
Correct answer: C
Rationale: Vernix caseosa is a white, cheesy substance that acts as a protective barrier on the skin of newborns, particularly present in skin folds. It helps to prevent dehydration and protect the delicate skin of the newborn from the amniotic fluid in utero. Educating expectant parents about the presence and function of vernix caseosa can help them understand the importance of its preservation during the immediate postnatal period. Choices A, B, and D are incorrect as they do not directly relate to the protective function of vernix caseosa in newborns. Milia are small, white bumps on the skin due to blocked oil glands, meconium is the first stool of a newborn and is typically dark green or black in color, and pseudostrabismus refers to false appearance of misalignment of the eyes, which usually resolves on its own without intervention.
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