HESI LPN
HESI Maternal Newborn
1. A client experiencing preterm labor is being taught about terbutaline by a nurse. Which statement by the client indicates an understanding of the teaching?
- A. “The medication could cause me to experience heart palpitations.â€
- B. “This medication could cause me to experience blurred vision.â€
- C. “This medication could cause me to experience ringing in my ears.â€
- D. “This medication could cause me to experience frequent urination.â€
Correct answer: A
Rationale: The correct answer is A. Terbutaline is a beta-adrenergic agonist used to stop preterm labor. One of its common side effects is heart palpitations due to its action on beta receptors in the heart. Choices B and C are incorrect because blurred vision and ringing in the ears are not common side effects of terbutaline. Choice D is irrelevant to the side effects of terbutaline.
2. A newborn is 1 hour old with a respiratory rate of 50/min, a heart rate of 130/min, and an axillary temperature of 36.1°C (97°F). Which of the following actions should be taken?
- A. Give the newborn a warm bath.
- B. Apply a cap to the newborn's head.
- C. Reposition the newborn.
- D. Obtain an oxygen saturation level.
Correct answer: B
Rationale: Applying a cap to the newborn's head is the correct action in this scenario. Newborns are at risk of heat loss due to their high surface area to volume ratio, and maintaining their body temperature is crucial to prevent hypothermia. Giving a warm bath can further increase heat loss and is not recommended. Repositioning the newborn may not address the primary concern of temperature regulation. While monitoring oxygen saturation is important, addressing thermal regulation takes precedence in this situation.
3. Chromosomes contain thousands of segments called:
- A. nuclei.
- B. nodes.
- C. capillaries.
- D. genes.
Correct answer: D
Rationale: Chromosomes are structures composed of DNA and genes. Genes are the functional segments within chromosomes that encode specific traits and characteristics. The other choices ('nuclei,' 'nodes,' 'capillaries') do not accurately describe the segments found within chromosomes and are unrelated to their structure or function.
4. Which of the following illnesses causes degeneration of the central nervous system?
- A. Tay-Sachs disease
- B. Cystic fibrosis
- C. Turner syndrome
- D. Klinefelter syndrome
Correct answer: A
Rationale: Tay-Sachs disease is a genetic disorder that causes a progressive degeneration of the central nervous system, particularly in infants. Choice B, Cystic fibrosis, is a genetic disorder that primarily affects the lungs and digestive system, not the central nervous system. Choices C and D, Turner syndrome and Klinefelter syndrome, are chromosomal disorders that do not directly involve degeneration of the central nervous system.
5. A client who is 24 weeks gestation arrives at the clinic reporting swollen hands. On examination, the nurse notes the client has had a rapid weight gain over six weeks. Which action should the nurse implement next?
- A. Review the client's previous blood pressures in the chart.
- B. Obtain the client's blood pressure.
- C. Observe and time the client's contractions.
- D. Examine the client for pedal edema.
Correct answer: B
Rationale: Swollen hands and rapid weight gain could be signs of preeclampsia, so the next step is to check the client's blood pressure. Elevated blood pressure is a key indicator in assessing for preeclampsia in pregnancy. Reviewing the client's previous blood pressures may provide additional context but obtaining the current blood pressure is crucial for immediate assessment. Observing and timing contractions are not relevant in this scenario as the client is not presenting with signs of active labor. Examining for pedal edema is important in assessing for fluid retention, but obtaining the blood pressure takes precedence in this case due to the potential seriousness of preeclampsia.
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