HESI RN OB EXAM

HESI RN OB .At 34- weeks gestation, a primigravida is assessed at her bimonthly clinic visist,. Which assessment finding is important for the nurse to report to the hcp? D. Weight gain of 7 pounds 2. A newborn infant is receiving immunization prior to discharge. Which action should the nurse implement? D. Obtain signed consent from the mother for administration of hepatitis B vaccine 3. A multiparous woman at 38-weeks gestation with a history of rapid progression of labor is admitted for induction due to signs and symptoms of preeclampsia. One hour after the Pitocin infusion is initiated, she complains of a headache. Her contractions are occurring every 1 to 2 minutes, lasting 60 to 75 seconds, and a vaginal exam indicates that her cervix is 90% effaced and dialted to 6 cm. What intervention is most important for the nurse to implement? C. Prepare for immediate delivery 4. Which topic is most important for the nurse to include in a nutrition teaching program for pregnant teenagers? B. Iron-deficieny anemia 5. The nurse is assessing a 38- week gestation newborn infant immediately following a vaginal birth. Which assessment finding best indicates that the infant is transitioning well to extra-uterine life? B. Cries vigorously when stimulated 6. While caring for a laboring client on continuous fetal monitoring, the nurse notes a fetal heartrate pattern that falls and rises abruptly with a “V” shaped appearance. What action should the nurse take first? D. Change the maternal position 7. A 32- week primigravida who is in preterm labor receives a prescription for an infusion of D5W 500 ml with magnesium sulfate 20 grams at 1 gram/hour. How many ml/hour should the nurse program the infusion pump? ANS: 25 ml 8. During the admission of a newborn, the nurse identifies a localized swelling that does not cross the suture line on the posterior area of the parietal bone. What action should the nurse implement? D. Notify the pediatrician of the cephalhematoma (THIS ONE DOES NOT CROSS THE SL & IS MORE CRITICAL) 9. The nurse if caring for a postpartum client who is complaining of severe pain and a feeling of pressure in her perineum. Her fundus if firm and she has a moderate lochial flow. On inspection, the nurse finds that a perineal hematoma is beginning to form. Which assessment finding should the nurse obtain first? A. Heart rate and blood pressure 10. During a postpartum assessment of a client who is 5 hours post vaginal delivery, the nurse determines the fundus is 3 finger breadths above the umbilicus and positioned to the client’s side. Which action should the nurse implement first? A. Encourage the client to void. 11. A multiparous client at 38- weeks gestation is admitted to labor and delivery with a compliant of contractions 5 minutes apart. While the client is in the bathroom changing into a hospital gown, the nurse hears a baby crying. What action should the nurse take first? D. Push the call light for help 12. A client who is receiving oxytocin (Pitocin) to augment early labor begins to experience hypersystolic or tetanic contractions with variable fetal heart decelerations. Which action should the nurse implement? Reposition the fetal monitor transducers B. Turn off the Pitocin infusion 13 . A client just delivered the placenta pictured below. For which of the following complications should the nurse carefully observe the woman? 2. Postpartum hemorrhage. 14. Which of the following is a priority nursing diagnosis for a woman, G10P6226, who is PP1 from a spontaneous vaginal delivery with a significant postpartum hemorrhage? 3. Fluid volume deficit related to blood loss. 15. A woman has just had a macrosomic baby after a 12-hour labor. For which of the following complications should the woman be carefully monitored? 1. Uterine atony. 16. On admission to the labor and delivery suite, the nurse assesses the discharge needs of a primipara who will be discharged home 4 days after a cesarean delivery. Which of the following questions should the nurse ask the client? 4. “Are there many stairs in your home?” 17. A woman is receiving Paxil (paroxetine) for postpartum depression. In order to prevent a drug/food interaction, the client must be advised to refrain from consuming which of the following? 1. Alcohol. 18. A nurse is assessing a 1 day-postpartum client who had a spontaneous vaginal delivery over an intact perineum. The fundus is firm at the umbilicus, lochia moderate, and perineum edematous. One hour after receiving ibuprofen 600 mg po, the client is complaining of perineal pain at level 9 on a 10 point scale. Based on this information, which of the following is an appropriate conclusion for the nurse to make about the client? 1. She should be assessed by her doctor. 19. A breastfeeding mother calls the obstetrician’s office with a complaint of pain in one breast. Upon inspection, a diagnosis of mastitis is made. Which of the following nursing interventions is appropriate? 2. Encourage the woman to breastfeed frequently. 20. A woman, who wishes to breastfeed, advises the nurse that she has had breast augmentation surgery. Which of the following responses by the nurse is appropriate? 4. Women who have implants are often able exclusively to breastfeed. 21. A breastfeeding client calls her obstetrician stating that her baby was diagnosed with thrush and that her breasts have become infected as well. Which of the following organisms has caused the baby’s and mother’s infection? 4. Candida albicans. 22. A client is on magnesium sulfate via IV pump for severe preeclampsia. Other than patellar reflex assessments, which of the following noninvasive assessments should the nurse perform to monitor the client for early signs of magnesium sulfate toxicity? 1. Serial grip strengths. 23. A woman, 26 weeks’ gestation, has just delivered a fetal demise. Which of the following nursing actions is appropriate at this time? 2. Dress the baby in a tee shirt and swaddle the baby in a receiving blanket. 24. A client, G1P0000, is PP1 from a normal spontaneous delivery of a baby boy, Apgar 5/6. Because the client exhibited addictive behaviors, a toxicology assessment was performed; the results were positive for alcohol and cocaine. Which of the following interventions is appropriate for this postpartum client? 4. Provide the client with supervised instruction on baby care skills. 25. A client is 10 minutes postpartum from a forceps delivery of a 4500-gram Down syndrome neonate over a right mediolateral episiotomy. The client is at risk for each of the following nursing diagnoses. Which of the diagnoses is highest priority at this time? 2. Fluid volume deficit. 26. A client is postpartum 24 hours from a spontaneous vaginal delivery with rupture of membranes for 42 hours. Which of the following signs/symptoms should the nurse report to the client’s health care practitioner? 1. Foul-smelling lochia. 27. A client is 36 hours post–cesarean section. Which of the following assessments would indicate that the client may have a paralytic ileus? 4. Absent bowel sounds. 28. A client, 1 day postpartum (PP), is being monitored carefully after a significant postpartum hemorrhage. Which of the following should the nurse report to the obstetrician? 1. Urine output 200 mL for last 8 hours. 29. The nurse is caring for a newborn infant who was recently diagnosed with congenital heart defect. Which assessment finding warrants immediate intervention by the nurse? C. Bluish tinge to the tongue 30. A client who delivered a healthy newborn an hour ago asks the nurse when can she go home. Which information is most important for the nurse to provide the client? A. When there is no significant vaginal bleeding 31. A client at 33- weeks gestation is admitted with a moderate amount of vaginal bleeding and no contractions are noted on the external monitor. Which intervention should the nurse implement? A. Weight perineal pads 32. The nurse is performing a gestational age assessment on a full-term newborn during the first hour of transition using the Ballard (Dubowitz) scale. Based on this assessment, the nurse determines that the neonate has a maturity rating of 40-weeks. What findings should the nurse identify to determine if the neonate is small for gestational age (SGA)? (Select all that apply.) A. Admission weight of 4 pounds, 15 ounces (2244 grams) B. Head to heel length of 17 inches (42.5 cm). C. Frontal occipital circumference of 12.5 inches (31.25 cm). 33. A client at 20 weeks gestation comes to the antepartum clinic complaining of vaginal warts (human papillomavirus). What information should the nurse provide this client? A. Treatment options, while limited due to the pregnancy, are available 34. One week after missing her menstrual period, a woman performs an OTC pregnancy test and it is positive. Which hormone is responsible for producing the positive result? C. Human chorionic gonadotrophin 35. A new mother, who is lacto-ovo vegetarian, plans to breastfeed her infant. What information should the nurse provide prior to discharge? B. Continue prenatal vitamins with B12 while breast feeding 36. Four clients arrive on the labor and delivery unit at the same time. Which client should the nurse assess first? B. A 39-week primigravida with biophysical profile score of 5 out of 8. 37.. A client with postpartum depression, who is admitted to the behavioral health unit, refuses to leave her room or eat meals. In addition to patient’s safety, which short-term goal should the nurse include in the plan of care? D) Consumes 3 meals and 1500 mL of fluid per day. 38A mother brings her 4-month-old son to the clinic with a quarter taped over his umbilicus and tells the nurse the quarter is supposed to fix her child’s hernia. Which explanations should the nurse provide? B) This hernia is a normal variation that resolves without treatment. 39. A new infant is receiving positive pressure ventilation after delivery. Based on which assessment finding should the nurse initiate chest compressions? B. Heart rate 54 40. During a Women’s Health Fair, which assignment is best for the practical nurse (PN) who is working with a registered nurse (RN)? D. Prepare a woman for a bone density screening. 41. The nurse is scheduling a client with gestational diabetes for an amniocentesis because the fetus has an estimated weight of 8 pounds at 36- weeks gestation. This amniocentesis is being performed to obtain which information? B. Fetal lung maturity 42. Vaginal prostaglandin gel is used to induce labor for a woman who is at 42 weeks gestation. Thirty minutes after insertion of the gel, the client complains of vaginal warmth, and is experiencing 90 second contractions with fetal heart rate decelerations. What action should the nurse implement first? C. Turn to a side-lying position 43. A woman who delivered a normal newborn 24 hours ago complains, “ I seem to be urinarting every hour or so. Is that ok?”. Which action should the nurse implement? B. Measure the next voiding, then palpate the clients bladder 44. A client whose labor is being augmented with an oxytocin (Pitocin) infusion requests an epidural for pain control. Findings f the last vaginal exam, performed 1 hour ago, were 3 cm cervical dilation, 60% effacement, and a -2 station. What action should the nurse implement first? A. Determine current cervical dilation 45. he nurse has taught a new admission to the postpartum unit about pericare. Which of the following indicates that the client understands the procedure? c) The woman sprays her perineum from front to back. 46. The nurse informs a postpartum woman that ibuprofen (Advil) is especially effective for afterbirth pains. What is the scientific rationale for this? b) Ibuprofen has an antiprostaglandin effect. 47. It is 4 p.m. A client, G1P0000, 3 cm dilated, asks the nurse when the dinner tray will be served. The nurse replies d) “A heavy meal is discouraged. I can get clear fluids for you whenever you would like them, though.” 48. A physician has ordered an iron supplement for a postpartum woman. The nurse strongly suggests that the woman take the medicine with which of the following drinks? c) Orange juice. 49.On admission to the labor and delivery unit, a client’s hemoglobin (Hgb) was assessed at 11.0 gm/dL, and her hematocrit (Hct) at 33%. Which of the following values would the nurse expect to see 2 days after a normal spontaneous vaginal delivery? c) Hgb 10.5 gm/dL; Hct 31%. 50. During a postpartum assessment, it is noted that a G1P1001 woman, who delivered vaginally over an intact perineum, has a cluster of hemorrhoids. Which of the following would be appropriate for the nurse to include in the woman’s health teaching? Select all that apply. a) The client should use a sitz bath daily as a relief measure. b) The client should digitally replace external hemorrhoids into her rectum. e) The client should apply topical anesthetic as a relief measure. 51. Which of the following is the priority nursing action during the immediate postpartum period? c) Perform pericare. 52. Immediately after delivery, a woman is shaking uncontrollably. Which of the following nursing actions is most appropriate? a. Provide the woman with warm blankets. 53. A client is receiving an epidural infusion of a narcotic for pain relief after a cesarean section. The nurse would report to the anesthesiologist if which of the following were assessed? a) Respiratory rate 8 rpm. 54. A client, 2 days postoperative from a cesarean section, complains to the nurse that she has yet to have a bowel movement since the surgery. Which of the following responses by the nurse would be appropriate at this time? d) “Fluids and exercise often help to combat constipation. Take a stroll around the unit and drink lots of fluid.” 55. A post–cesarean section, breastfeeding client, whose subjective pain level is 2/5, requests her as needed (prn) narcotic analgesics every 3 hours. She states, “I have decided to make sure that I feel as little pain from this experience as possible.” Which of the following should the nurse conclude in relation to this woman’s behavior? b) The woman is high risk for severe constipation.