MATERNITY HESI TEST BANK
ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES GRADED A+
An expectant father tells the nurse he fears that his wife is "losing her
mind." He states that she is constantly rubbing her abdomen and talking
to the baby and that she actually reprimands the baby when it moves too
much. Which recommendation should the nurse make to this expectant
father?
A.Suggest that his wife seek professional counseling to deal with her
symptoms.
B.Explain that his wife is exhibiting ambivalence about the pregnancy.
C. Ask him to report similar abnormal behaviors at the next prenatal
visit.
,D.Reassure him that normal maternal-fetal bonding is occurring. -
ANSWER- D) Reassure him that normal maternal-fetal bonding is
occurring.
Rationale:
These behaviors are positive signs of maternal-fetal bonding and do
not reflect ambivalence. No intervention is needed. Quickening, the
first perception of fetal movement, occurs at 17 to 20 weeks of
gestation and begins a new phase of prenatal bonding during the
second trimester. Options A and C are not necessary because the
behaviors displayed are normal.
The nurse is preparing a laboring client for an amniotomy. Immediately
after the procedure is completed, it is most important for the nurse to
obtain which information?
A.Maternal blood pressure
B.Maternal temperature
C.Fetal heart rate (FHR)
D.White blood cell count (WBC) - ANSWER- C. Fetal heart rate
(FHR)
Rationale:
,The FHR should be assessed before and after the procedure to
detect changes that may indicate the presence of cord compression
or prolapse. An amniotomy (artificial rupture of membranes
[AROM]) is used to stimulate labor when the condition of the cervix
is favorable. The fluid should be assessed for color, odor, and
consistency. Option A should be assessed every 15 to 20 minutes
during labor but is not specific for AROM. Option B is monitored
hourly after the membranes are ruptured to detect the development
of amnionitis. Option D should be determined for all clients in labor.
A nurse receives a shift change report for a newborn who is 12 hours
post-vaginal delivery. In developing a plan of care, the nurse should give
the highest priority to which finding?
A.Cyanosis of the hands and feet
B.Skin color that is slightly jaundiced
C.Tiny white papules on the nose or chin
D.Red patches on the cheeks and trunk - ANSWER- B. Skin color that
is slightly jaundiced
Rationale: Jaundice, a yellow skin coloration, is caused by elevated
levels of bilirubin, which should be further evaluated in a newborn
<24 hours old. Acrocyanosis (blue color of the hands and feet) is a
common finding in newborns; it occurs because the capillary system
, is immature. Milia are small white papules present on the nose and
chin that are caused by sebaceous gland blockage and disappear in a
few weeks. Small red patches on the cheeks and trunk are called
erythema toxicum neonatorum, a common finding in newborns.
A breastfeeding postpartum client is diagnosed with mastitis, and
antibiotic therapy is prescribed. Which instruction should the nurse
provide to this client?
A.Breastfeed the infant, ensuring that both breasts are completely
emptied.
B.Feed expressed breast milk to avoid the pain of the infant latching
onto the infected breast.
C.Breastfeed on the unaffected breast only until the mastitis subsides.
D.Dilute expressed breast milk with sterile water to reduce the
antibiotic effect on the infant. - ANSWER- A.Breastfeed the infant,
ensuring that both breasts are completely emptied.
Rationale:Mastitis, caused by plugged milk ducts, is related to
breast engorgement, and breastfeeding during mastitis facilitates
the complete emptying of engorged breasts, eliminating the pressure
on the inflamed breast tissue. Option B is less painful but does not
facilitate complete emptying of the breast tissue. Option C will not
ACTUAL EXAM QUESTIONS AND
CORRECT ANSWERS WITH
RATIONALES GRADED A+
An expectant father tells the nurse he fears that his wife is "losing her
mind." He states that she is constantly rubbing her abdomen and talking
to the baby and that she actually reprimands the baby when it moves too
much. Which recommendation should the nurse make to this expectant
father?
A.Suggest that his wife seek professional counseling to deal with her
symptoms.
B.Explain that his wife is exhibiting ambivalence about the pregnancy.
C. Ask him to report similar abnormal behaviors at the next prenatal
visit.
,D.Reassure him that normal maternal-fetal bonding is occurring. -
ANSWER- D) Reassure him that normal maternal-fetal bonding is
occurring.
Rationale:
These behaviors are positive signs of maternal-fetal bonding and do
not reflect ambivalence. No intervention is needed. Quickening, the
first perception of fetal movement, occurs at 17 to 20 weeks of
gestation and begins a new phase of prenatal bonding during the
second trimester. Options A and C are not necessary because the
behaviors displayed are normal.
The nurse is preparing a laboring client for an amniotomy. Immediately
after the procedure is completed, it is most important for the nurse to
obtain which information?
A.Maternal blood pressure
B.Maternal temperature
C.Fetal heart rate (FHR)
D.White blood cell count (WBC) - ANSWER- C. Fetal heart rate
(FHR)
Rationale:
,The FHR should be assessed before and after the procedure to
detect changes that may indicate the presence of cord compression
or prolapse. An amniotomy (artificial rupture of membranes
[AROM]) is used to stimulate labor when the condition of the cervix
is favorable. The fluid should be assessed for color, odor, and
consistency. Option A should be assessed every 15 to 20 minutes
during labor but is not specific for AROM. Option B is monitored
hourly after the membranes are ruptured to detect the development
of amnionitis. Option D should be determined for all clients in labor.
A nurse receives a shift change report for a newborn who is 12 hours
post-vaginal delivery. In developing a plan of care, the nurse should give
the highest priority to which finding?
A.Cyanosis of the hands and feet
B.Skin color that is slightly jaundiced
C.Tiny white papules on the nose or chin
D.Red patches on the cheeks and trunk - ANSWER- B. Skin color that
is slightly jaundiced
Rationale: Jaundice, a yellow skin coloration, is caused by elevated
levels of bilirubin, which should be further evaluated in a newborn
<24 hours old. Acrocyanosis (blue color of the hands and feet) is a
common finding in newborns; it occurs because the capillary system
, is immature. Milia are small white papules present on the nose and
chin that are caused by sebaceous gland blockage and disappear in a
few weeks. Small red patches on the cheeks and trunk are called
erythema toxicum neonatorum, a common finding in newborns.
A breastfeeding postpartum client is diagnosed with mastitis, and
antibiotic therapy is prescribed. Which instruction should the nurse
provide to this client?
A.Breastfeed the infant, ensuring that both breasts are completely
emptied.
B.Feed expressed breast milk to avoid the pain of the infant latching
onto the infected breast.
C.Breastfeed on the unaffected breast only until the mastitis subsides.
D.Dilute expressed breast milk with sterile water to reduce the
antibiotic effect on the infant. - ANSWER- A.Breastfeed the infant,
ensuring that both breasts are completely emptied.
Rationale:Mastitis, caused by plugged milk ducts, is related to
breast engorgement, and breastfeeding during mastitis facilitates
the complete emptying of engorged breasts, eliminating the pressure
on the inflamed breast tissue. Option B is less painful but does not
facilitate complete emptying of the breast tissue. Option C will not
