HESI RN
HESI RN Care of Women and Pediatric Nursing Questions
Extract:
Question 1 of 5
A client at 40 weeks gestation is admitted in active labor, and laboratory findings indicate that she is HIV positive. Which action(s) should the nurse plan to perform? Select all that apply.
Correct Answer: A,B,D
Rationale: Standard precautions ' prevent HIV transmission. Antiviral medication ' reduces vertical transmission risk. Bottle-feeding ' prevents postnatal transmission via breast milk. Droplet precautions ' and negative pressure rooms ' are unnecessary as HIV is not airborne.
Question 2 of 5
The nurse is caring for a term infant immediately following delivery. Which action should the nurse implement to reduce the risk of cold stress?
Correct Answer: D
Rationale: Drying and skin-to-skin contact ' prevent cold stress by maintaining warmth and promoting bonding. Bathing ', radiant warmer ', and room temperature ' are less effective or inappropriate immediately.
Question 3 of 5
In preparing a gravid client for a triple screen analysis, which action should the nurse take?
Correct Answer: C
Rationale: Triple screen analysis requires a maternal blood sample to assess fetal abnormality risks. Preparing to draw blood ' is the correct action. Drinking water ', left lateral position ', and fetal monitoring ' are unrelated to this test.
Question 4 of 5
A woman at 36 weeks gestation who is Rh negative is admitted to labor and delivery reporting abdominal cramping. She is placed on strict bedrest and the fetal heart rate and contraction pattern are monitored with an external fetal monitor. Two hours after admission, the nurse notes a large amount of bright red vaginal bleeding. Which nursing intervention has the highest priority?
Correct Answer: A
Rationale: Bright red vaginal bleeding at 36 weeks is a critical sign of potential placental issues. Assessing fetal heart rate and contractions ' is the highest priority to evaluate fetal well-being. Confirming Rh status ' is secondary. Leopold maneuvers ' and vaginal exams ' are not immediate priorities and may worsen bleeding.
Question 5 of 5
The current vital signs for a primipara who delivered vaginally during the previous shift are: temperature 100.4°F (38°C), heart rate 58 beats/minute, respiratory rate 16 breaths/minute, and blood pressure 130/74 mm Hg. Which action should the nurse implement?
Correct Answer: A
Rationale: The vital signs are within normal postpartum ranges. A temperature of 100.4°F can be normal due to labor exertion, and a heart rate of 58 beats/minute is typical due to increased stroke volume. Documenting ' is appropriate. Assessing lochia ', administering acetaminophen ', or reporting the heart rate ' are not indicated without further concerns.