a multiparous woman has been in labor for 8 hours her membranes have just ruptured what is the nurses highest priority in this situation
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HESI Maternity 55 Questions

1. A multiparous woman has been in labor for 8 hours. Her membranes have just ruptured. What is the nurse’s highest priority in this situation?

Correct answer: D

Rationale: The correct answer is to assess the fetal heart rate (FHR) and pattern (Choice D). When a multiparous woman's membranes rupture after 8 hours of labor, the nurse's priority is to assess the fetal well-being. Rupture of membranes can lead to potential complications such as umbilical cord prolapse. Monitoring the fetal heart rate and pattern immediately after the rupture of membranes is crucial to ensure the fetus is not in distress. This assessment helps in determining the need for immediate interventions to safeguard the fetus. Documenting the characteristics of the fluid (Choice C) may be necessary but is of lower priority compared to assessing fetal well-being. While preparing the woman for imminent birth (Choice A) is important, assessing the fetal heart rate takes precedence to ensure the fetus is not compromised. Notifying the woman's primary healthcare provider (Choice B) is also important but not the highest priority at this moment.

2. What is the primary role of meiosis in the production of sperm and ova?

Correct answer: A

Rationale: The correct answer is A. Meiosis is a type of cell division that reduces the chromosome number by half, resulting in the formation of sperm and ova. Choice B is incorrect because meiosis does not increase the chromosome number. Choice C is incorrect because meiosis creates genetically diverse gametes, not identical copies of chromosomes. Choice D is incorrect because meiosis does not primarily function to repair damaged chromosomes.

3. Is Duchenne muscular dystrophy a sex-linked abnormality?

Correct answer: A

Rationale: The correct answer is A: TRUE. Duchenne muscular dystrophy is an X-linked recessive disorder, primarily affecting males. This is due to the inheritance of the mutated gene on the X chromosome. Choices B, C, and D are incorrect because Duchenne muscular dystrophy is specifically classified as a sex-linked disorder affecting males due to the inheritance pattern.

4. Individuals with Klinefelter syndrome produce:

Correct answer: B

Rationale: Individuals with Klinefelter syndrome have an extra X chromosome (XXY), leading to reduced production of testosterone, the primary male sex hormone. This deficiency can result in various physical and developmental characteristics associated with the syndrome. Estrogen levels may actually be relatively elevated due to the imbalance between testosterone and estrogen. Choices C and D are incorrect as adenine and thymine are nucleotide bases found in DNA and are not related to hormone production.

5. A client has experienced a fetal demise following a vaginal delivery at term. What should the nurse advise the client?

Correct answer: A

Rationale: After a fetal demise, allowing the parents to bathe and dress their baby can offer them a sense of closure and help them in their grieving process. This act can provide a tangible way for the parents to bond with their baby and create lasting memories. Option B is incorrect because each individual may have different emotional needs and holding the baby may not be appropriate or helpful for everyone. Option C, while well-intentioned, may not be suitable for all parents as naming the baby could be emotionally challenging. Option D is insensitive as it overlooks the grieving process of losing a baby by suggesting a replacement.

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