Monroe College RN HESI Maternity | Nurselytic

Questions 55

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Monroe College RN HESI Maternity Questions

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Question 1 of 5

A client at 28 weeks gestation is in preterm labor and it is not expected that the fetus will survive after delivery. What should be the nurse's initial action?

Correct Answer: A

Rationale: In a situation where a client at 28 weeks gestation is in preterm labor and it is not expected that the fetus will survive after delivery, the nurse's initial action should be to contact spiritual support services. This can provide much-needed emotional and spiritual support to the client during this difficult time.

Question 2 of 5

What should be the primary focus of nursing care in the transitional phase of labor for a client who anticipates an unmedicated delivery?

Correct Answer: D

Rationale: Assisting the woman to maintain control is the primary focus of nursing care during the transitional phase of labor. This includes providing supportive care and encouragement in dealing with transitional contractions.

Question 3 of 5

A patient in early labor is receiving oxytocin and begins to experience tachysystolic or tetanic contractions with variable fetal heart decelerations. What should the nurse do next?

Correct Answer: B

Rationale: Discontinuing the oxytocin infusion is the correct action. Oxytocin is a hormone that stimulates uterine contractions during labor. If a patient begins to experience tachysystolic or tetanic contractions, which are excessively frequent or prolonged contractions, it could lead to fetal distress. Discontinuing the oxytocin can help reduce the frequency and intensity of the contractions.

Question 4 of 5

A client, who is three days postpartum and formula feeding her newborn, reports experiencing painful, hard, and full breasts to the nurse. What recommendation should the nurse provide?

Correct Answer: D

Rationale: Wearing a form-fitting bra for the next couple of days can provide support and help reduce the discomfort associated with engorgement in a formula-feeding mother.

Question 5 of 5

What physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?

Correct Answer: C

Rationale: A pulse rate of 56 beats/minute can be a normal finding postpartum. Pregnancy increases blood volume and cardiac output, and these changes can persist for some time after delivery.

Similar Questions

The nurse is caring for a client who delivered 6 hours ago. The client's uterus is boggy and is displaced above and to the right of the umbilicus. What action should the nurse take?
After breastfeeding for 10 minutes on each breast, a new mother calls the nurse to the postpartum room to assist with changing the newborn's diaper.As the mother begins the diaper change, the newborn regurgitates the breast milk. What should be the nurse's first action?
A client who is 3 weeks postpartum tells the nurse, “I am so tired all the time.I didn't realize having a baby would be this challenging.”. What should the nurse's response be?
A 25-year-old client experienced a severe postpartum hemorrhage following the vaginal birth of twins and is now transferred to the postpartum unit. What complication should the nurse prioritize during the client's assessment?
A client at 32 weeks gestation visits the women's health clinic and reports feeling nauseous and vomiting. Upon examination, the nurse notes that the client's blood pressure is elevated. What should the nurse do next?

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