HESI RN
HESI RN Maternity Exam 7n Questions
Extract:
Question 1 of 5
The nurse is reviewing a client's chart. Click to highlight areas of client history and physical below that increase the risk for postpartum hemorrhage. Client was middle-aged and married. She was in labor for 25 hours and forceps were used to assist with the delivery. She was given an epidural for anesthesia that was effective. The labor and delivery nurse reported that the client had a 4th degree laceration, and her pain was currently at a 4 on a 0 to 10 pain scale. Her vital signs were stable, and she was catheterized for 500 mL of light-yellow urine just prior to delivery. Her spouse was at the bedside for delivery.
Correct Answer: B,C,D
Rationale: Forceps use, prolonged labor (25 hours), and 4th degree laceration increase postpartum hemorrhage risk due to trauma and uterine atony.
Question 2 of 5
The MMR vaccine (measles, mumps, and rubella) is given subcutaneously at a dose of 0.5 mL if the patient is not immune to rubella. How should the risk of Venous Thromboembolism (VTE) and Postpartum Hemorrhage (PPH) be evaluated?
Correct Answer: B
Rationale: MMR vaccination does not directly increase VTE or PPH risk. Evaluating based on overall health and pregnancy factors, with prophylaxis for moderate to high risk, is appropriate per policy.
Question 3 of 5
A 3-year-old male was brought into the emergency room this morning with a sudden onset of 'fast and noisy breathing'. What other symptoms is the nurse likely to note in a child diagnosed with epiglottitis?
Correct Answer: B
Rationale: A thick, muffled voice is characteristic of epiglottitis due to epiglottal swelling. Wheezing, purulent discharge, productive cough, and dyspnea are less specific.
Question 4 of 5
A client's maternal serum alpha-fetoprotein level is elevated at 17 weeks. What condition should the nurse identify as the likely cause of this increase?
Correct Answer: D
Rationale: Elevated maternal serum alpha-fetoprotein at 17 weeks is most commonly associated with neural tube defects. Multiple gestation may also increase levels but is less likely, while Down syndrome and fetal hypoxia typically do not cause this elevation.
Question 5 of 5
Assessment findings of a 4-hour-old newborn include: axillary temperature of 96.8° F (35.8° C), heart rate of 150 beats/minute with a soft murmur, irregular respiratory rate at 64 breaths/minute, jitteriness, hypotonic, and weak cry. Based on these findings, which action should the nurse implement?
Correct Answer: D
Rationale: Jitteriness, hypotonia, and weak cry suggest hypoglycemia. A heel stick glucose test is urgent to confirm and treat this condition.