HESI RN
Monroe College RN HESI Maternity Questions
Extract:
Question 1 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 2 of 5
One day after vaginal delivery of a full-term baby, a postpartum client's white blood cell count is 15,000/mm (15 x 109/L). What action should the nurse take first?
Correct Answer: D
Rationale: A normal WBC in a postpartum client ranges from (12,000- 20, 000/mm. Checking the white blood cell differential helps determine the specific types of WBCs present and gives more information as to whether the elevation is the body's normal response to childbirth or a sign of infection.
Question 3 of 5
A client at 40-weeks gestation arrives at the obstetrical floor and reports that her amniotic membranes ruptured spontaneously at home. She is in active labor and feels the need to bear down and push. What is the most important information for the nurse to obtain?
Correct Answer: C
Rationale: The time the membranes ruptured is the most important information to obtain. This is because the risk of infection increases the longer the time between membrane rupture and delivery. Knowing the time of rupture helps guide decisions about inducing labor and administering antibiotics to prevent infection.
Question 4 of 5
The nurse receives a newborn within the first minutes after a vaginal delivery and intervenes to establish adequate respirations. What priority issue should the nurse address to ensure the newborn's survival?
Correct Answer: A
Rationale: Heat loss is a significant concern for newborns immediately after birth. Newborns have a large surface area relative to their body weight, which makes them more susceptible to heat loss. Maintaining a warm environment is crucial to prevent hypothermia, which can lead to complications such as hypoglycemia and respiratory distress.
Question 5 of 5
A client who is at 10-weeks gestation calls the clinic because she has been vomiting for the past 24 hours. The nurse determines that the client has no fever. What instruction should the nurse give to this client?
Correct Answer: C
Rationale: The best course of action in this situation is for the woman to come to the clinic to be seen by a healthcare provider. Prolonged vomiting can lead to dehydration and electrolyte imbalances, which can be harmful to both the mother and the fetus.