HESI LPN
HESI Maternal Newborn
1. A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?
- A. Provide a calm environment
- B. Monitor blood glucose levels every hour
- C. Initiate seizure precautions
- D. Place the infant on their back with legs extended
Correct answer: C
Rationale: Initiating seizure precautions is crucial when caring for an infant with neonatal abstinence syndrome due to the increased risk of seizures. Providing a calm environment (Choice A) is important to reduce stimulation as these infants may be irritable. Monitoring blood glucose levels (Choice B) is not typically a priority in neonatal abstinence syndrome unless specific signs or symptoms suggest the need for this assessment. Placing the infant on their back with legs extended (Choice D) does not directly address the potential complications associated with neonatal abstinence syndrome, such as seizures.
2. A client at 20 weeks of gestation has trichomoniasis. Which of the following findings should the nurse expect?
- A. Thick, White Vaginal Discharge
- B. Urinary Frequency
- C. Vulvar Lesions
- D. Malodorous Discharge
Correct answer: D
Rationale: Malodorous discharge is a common symptom of trichomoniasis caused by the Trichomonas vaginalis parasite. It is typically described as frothy, greenish-yellow, and malodorous. Choices A, B, and C are incorrect findings associated with other conditions. Thick, white vaginal discharge is more characteristic of a yeast infection; urinary frequency may be seen in urinary tract infections; and vulvar lesions are commonly seen in herpes simplex virus infections.
3. On the first postpartum day, the nurse examines the breasts of a new mother. Which condition is the nurse most likely to find?
- A. Firm, larger, and very tender to the touch
- B. Slightly firm with an immediate let-down response
- C. Soft with no change from before delivery
- D. Filling and secreting colostrum
Correct answer: D
Rationale: On the first postpartum day, the nurse is most likely to find the breasts filling and secreting colostrum. Colostrum secretion is common as the body prepares for breastfeeding in the initial days after delivery. Choice A is incorrect as breasts are not typically very tender immediately postpartum. Choice B is incorrect as an immediate let-down response is more related to lactation rather than the first postpartum day. Choice C is incorrect as the breasts typically undergo changes, such as filling with colostrum, after delivery.
4. After a mother was diagnosed with gonorrhea immediately after delivery, what is an important goal of the nurse when providing care for her baby?
- A. Prevent the development of ophthalmia neonatorum.
- B. Lubricate the eyes.
- C. Prevent the development of infection.
- D. Teach about the risks of breastfeeding with gonorrhea.
Correct answer: A
Rationale: The correct answer is A: Prevent the development of ophthalmia neonatorum. When a mother has gonorrhea, the baby can be infected during delivery, leading to ophthalmia neonatorum, which can cause permanent blindness. Therefore, it is crucial for the nurse to prevent this condition by treating the baby's eyes with an antibiotic prophylactically after birth. Choice B, lubricating the eyes, is not the primary goal in this situation as preventing infection takes precedence. Choice C, preventing the development of infection, is too broad and does not specifically address the potential complication of ophthalmia neonatorum. Choice D, teaching about the risks of breastfeeding with gonorrhea, is important but not the immediate goal in this scenario where preventing ophthalmia neonatorum and potential blindness is the priority.
5. Daisy was always unusually short for her age. She was unable to conceive a child after marriage, and upon visiting a doctor, she was prescribed estrogen replacement therapy. Daisy is most likely suffering from:
- A. Phenylketonuria (PKU).
- B. Cystic fibrosis.
- C. Turner syndrome.
- D. Huntington’s disease (HD).
Correct answer: C
Rationale: Daisy's symptoms of short stature and infertility, along with the prescription of estrogen replacement therapy, are indicative of Turner syndrome. Turner syndrome is a genetic condition in which a female is partially or completely missing one X chromosome. This results in short stature, infertility, and other physical characteristics. Phenylketonuria (PKU) is a metabolic disorder caused by a mutation in the gene responsible for the breakdown of the amino acid phenylalanine. Cystic fibrosis is a genetic disorder affecting the respiratory and digestive systems. Huntington's disease (HD) is a neurodegenerative disorder that affects muscle coordination and leads to cognitive decline.
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