HESI LPN
HESI Focus on Maternity Exam
1. A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include?
- A. Focusing on controlling body functions
- B. Synchronized breathing is often helpful during hypnosis
- C. Hypnosis can be beneficial if practiced during the prenatal period
- D. Hypnosis is ineffective for controlling pain associated with labor
Correct answer: C
Rationale: Hypnosis can be an effective method of pain control during labor, especially if practiced during the prenatal period. Choice A is not specific to hypnosis and may not be directly related. Choice B is not essential for hypnosis and may not always be required. Choice D is incorrect as hypnosis has been shown to be beneficial for managing labor pain when done correctly, making it an inappropriate option to include in the teaching.
2. Which of the following is a sexually transmitted infection that, in advanced stages, can attack major organ systems?
- A. Rubella
- B. Syphilis
- C. Cystic fibrosis
- D. Phenylketonuria
Correct answer: B
Rationale: Syphilis is the correct answer. Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. If left untreated, it can progress through various stages and potentially attack major organ systems, causing severe complications. Rubella, Cystic fibrosis, and Phenylketonuria are not sexually transmitted infections. Rubella is a viral infection, Cystic fibrosis is a genetic disorder affecting the lungs and digestive system, and Phenylketonuria is a genetic metabolic disorder. These conditions do not typically affect major organ systems in the same way as untreated syphilis.
3. What nursing action should the nurse implement for a 3-hour-old male infant who presents with cyanotic hands and feet, an axillary temperature of 96.5°F (35.8°C), a respiratory rate of 40 breaths per minute, and a heart rate of 165 beats per minute?
- A. Administer oxygen by mouth at 2L/min
- B. Gradually warm the infant under a radiant heat source
- C. Notify the pediatrician of the infant's vital signs
- D. Perform a heel-stick to maintain blood glucose levels
Correct answer: B
Rationale: The correct nursing action is to gradually warm the infant under a radiant heat source. The infant is presenting with signs of cold stress, indicated by cyanotic extremities and a low body temperature. Gradual warming is crucial to stabilize the infant's temperature and prevent further complications. Administering oxygen, notifying the pediatrician, or performing a heel-stick are not the priority actions in this scenario and may not address the immediate need to raise the infant's body temperature.
4. A newborn nursery protocol includes a prescription for ophthalmic erythromycin 5% ointment to both eyes upon a newborn's admission. What action should the nurse take to ensure adequate installation of the ointment?
- A. Instill a thin ribbon into each lower conjunctival sac
- B. Occlude the inner canthus after retracting the eyelids
- C. Mummy wrap the infant before instilling the ointment
- D. Stabilize the instilling hand on the neonate's head
Correct answer: A
Rationale: To ensure adequate installation of the ophthalmic erythromycin 5% ointment in a newborn, the nurse should instill a thin ribbon into each lower conjunctival sac. This method helps to ensure proper distribution and effectiveness of the medication to prevent neonatal conjunctivitis. Choices B, C, and D are incorrect. Occluding the inner canthus after retracting the eyelids, mummy wrapping the infant, or stabilizing the instilling hand on the neonate's head are not appropriate actions for ensuring the proper installation of the ointment.
5. If an individual receives a recessive gene for eye color from both parents, the:
- A. gender of the child will not determine the expression of that trait.
- B. recessive trait will be expressed in the child.
- C. recessive trait will be expressed in all the offspring.
- D. recessive trait will be suppressed, and the dominant trait will not be expressed.
Correct answer: B
Rationale: When an individual inherits a recessive gene for eye color from both parents, the recessive trait will be expressed in the child. This is because having two copies of the recessive gene overrides the presence of any dominant gene. Choice A is incorrect because the expression of the trait is determined by the genetic makeup, not the gender of the child. Choice C is incorrect as the expression of the recessive trait is certain when both parents pass on the recessive gene, but it does not mean that all offspring will express the trait. Choice D is incorrect because if both parents provide a recessive gene, the dominant trait will not be expressed in the child, but it does not mean it will be suppressed; rather, the recessive trait will be expressed.
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