HESI RN
HESI RN Care of Women and Pediatric Nursing Questions
Extract:
Question 1 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 2 of 5
A woman in her third trimester of pregnancy has been in active labor for the past 8 hours and has dilated 3 cm. The nurse's assessment findings and electronic fetal monitoring (EFM) are consistent with hypotonic dystocia, and the healthcare provider prescribes an oxytocin drip. Which data is most important for the nurse to monitor?
Correct Answer: D
Rationale: Hypotonic dystocia involves weak contractions. Monitoring intensity, interval, and length of contractions ' is critical to assess oxytocin effectiveness. Blood pressure ', cesarean prep ', and perineal bulging ' are secondary.
Question 3 of 5
A client at 37 weeks gestation presents with contractions every 3 to 4 minutes, lasting 60 seconds. The fetal heart rate is noted to be 140 bpm, and no abnormal fetal movements are observed. The client reports no pain and normal laboratory results. Which action should the nurse implement first?
Correct Answer: B
Rationale: Checking cervical dilation ' assesses labor progress, guiding management. Oxygen ', IV fluids ', and delivery prep ' are not indicated with normal fetal heart rate and no distress.
Question 4 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 5 of 5
A client whose labor is being augmented with an oxytocin infusion requests an epidural for pain control. Findings of the last vaginal exam, performed one hour ago, were 3 cm cervical dilation, 60% effacement, and a -2 station. Which action should the nurse implement first?
Correct Answer: B
Rationale: Determining current cervical dilation ' ensures appropriate epidural timing. Requesting epidural ', adjusting oxytocin ', or giving fluids ' should follow labor progress assessment.