HESI LPN
HESI Focus on Maternity Exam
1. As women reach the end of their childbearing years, does ovulation become more regular?
- A. TRUE
- B. FALSE
- C. Rarely
- D. Always
Correct answer: B
Rationale: The correct answer is B: FALSE. As women age and reach the end of their childbearing years, ovulation becomes less regular due to hormonal changes associated with menopause. This can result in irregular ovulation patterns or even the cessation of ovulation entirely. Choice A is incorrect because ovulation does not become more regular with age. Choices C and D are also incorrect as they do not accurately reflect the changes in ovulation patterns that occur as women approach the end of their childbearing years.
2. A mother spontaneously delivers a newborn infant in the taxicab while on the way to the hospital. The emergency room nurse reported the mother has active herpes (HSV II) lesions on the vulva. Which intervention should the nurse implement first when admitting the neonate to the nursery?
- A. Document the newborn's temperature on the flow sheet.
- B. Place the newborn in the isolation area of the nursery.
- C. Obtain a blood specimen for a serum glucose level.
- D. Administer the vitamin K injection.
Correct answer: B
Rationale: Newborns exposed to active herpes lesions are at high risk for neonatal herpes, which can be severe. Placing the newborn in isolation is crucial as it helps prevent the spread of the virus and allows for close monitoring. Documenting the newborn's temperature, obtaining a blood specimen for a serum glucose level, and administering the vitamin K injection are important interventions but are not the priority when dealing with a potential infectious risk like neonatal herpes.
3. A nurse is caring for a newborn who is 6 hours old and has a bedside glucometer reading of 65 mg/dL. The newborn’s mother has type 2 diabetes mellitus. Which of the following actions should the nurse take?
- A. Obtain a blood sample for a serum glucose level
- B. Feed the newborn immediately
- C. Administer 50 mL of dextrose solution IV
- D. Reassess the blood glucose level prior to the next feeding
Correct answer: D
Rationale: A bedside glucometer reading of 65 mg/dL is within the normal range for a newborn. Reassessing the blood glucose level prior to the next feeding ensures ongoing monitoring without unnecessary intervention. Obtaining a blood sample for a serum glucose level (Choice A) is not necessary as the initial reading is normal. Feeding the newborn immediately (Choice B) may not be indicated and could lead to unnecessary interventions. Administering dextrose solution IV (Choice C) is not warranted as the glucose level is within the normal range and does not require immediate correction.
4. What should be the primary focus of nursing care in the transitional phase of labor for a client who anticipates an unmedicated delivery?
- A. Assessing the strength of uterine contractions
- B. Re-evaluating the need for medication
- C. Reminding her to push 3 times with each contraction
- D. Assisting her to maintain control
Correct answer: D
Rationale: During the transitional phase of labor, which is the most intense phase, the primary focus of nursing care for a client who anticipates an unmedicated delivery should be assisting her to maintain control. This is essential to help her manage the intense pain and anxiety associated with this phase without the use of medication. Assessing the strength of uterine contractions (Choice A) is important but not the primary focus during the transitional phase. Re-evaluating the need for medication (Choice B) is not applicable as the client anticipates an unmedicated delivery. Reminding her to push 3 times with each contraction (Choice C) is more related to the pushing stage of labor and not the transitional phase.
5. A new parent is receiving discharge teaching about car seat safety from a nurse. Which statement by the parent indicates an understanding of the teaching?
- A. “I should position my baby’s car seat at a 45-degree angle in the car.”
- B. “I should place the car seat rear-facing until my baby is 12 months old.”
- C. “I should place the harness snugly in a slot above my baby’s shoulders.”
- D. “I should position the retainer clip at the top of my baby’s abdomen.”
Correct answer: A
Rationale: The correct answer is A. Positioning the car seat at a 45-degree angle is crucial to prevent the baby's head from falling forward, which can obstruct the airway. Choice B is incorrect because the recommendation is to keep the car seat rear-facing until the baby reaches the height or weight limit set by the car seat manufacturer, typically beyond 12 months. Choice C is incorrect as the harness should be snugly placed at or below the baby's shoulders, not above. Choice D is incorrect as the retainer clip should be positioned at armpit level to secure the harness straps properly.
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