RN HESI Maternal Newborn Study Set EXAM GRADED A+ QUESTIONS AND CORRECT
ANSWERS 100% VERIFIED
A two year old child with heart failure (HF) is admitted for replacement of a
graft for coarctation of the aorta. Prior to administering the next dose of
digoxin (Lanoxin) the nurse obtains an apical heart rate of 128 bpm. What
action should the nurse implement?
a. Determine the pulse deficit
b. Administer the scheduled dose
c. Calculate the safe dose range
d. Review the serum digoxin level
b. Administer the scheduled dose
Which nursing intervention is most important to include in the plan of care for
a child with acute glomerulonephritis?
a. Encourage fluid intake
b. Promote complete bed rest
c. Weight the child daily
d. Administer vitamin supplements
c. Weight the child daily
A 7 year old child is admitted to the hospital with acute glomerulonephritis
(AGN). When obtaining the nursing history, which finding should the nurse
expect to obtain?
a. High blood cholesterol level on routine screening
b. Increased thirst and urination
c. A recent strep throat infection
d. A recent DPT immunization
c. A recent strep throat infection
,A child with leukemia is admitted for Chemotherapy with a nursing diagnosis
of "altered nutrition, less than body requirements related to anorexia, nausea
and vomiting". Which intervention should the nurse include in this child plan
of care?
Allow the child to eat any food desired and tolerated.
A client delivers a viable infant, but begins to have excessive uncontrolled
vaginal bleeding after the IV Pitocin is infused. When notifying the healthcare
provider of the condition, what information is most important for the nurse to
provide?
Maternal blood pressure
A new mother is having trouble breast feeding her newborn son. He is making
frantic rooting motions and will not grasp the nipple. What intervention would
be most helpful to this mother?
Ask the mother to stop the feeding, comfort the infant, and then assist the mother to
help the baby latch on.
A blind little girl, 8 years old was admitted to the hospital. What should be
brought to help comfort her during her hospital stay?
Bring familiar toys from home such as bear, doll.
What helps relieve pain associated with mastitis?
Ice packs
A nurse is admitting a client to the labor and delivery unit when the client
states, "my water just broke", which of the following is the priority intervention
for the nurse to take?
a. Perform Nitrazine testing
b. Assess the amniotic fluid
c. Check cervical dilation
d. Monitor the fetal heart rate
d. Monitor the fetal heart rate
Rupture of the membranes places the fetus at risk for umbilical cord prolapse.
A nurse is caring for a client undergoing an oxytocin-stimulated contraction
test. The nurse notes three contractions in 10 min with late decelerations
occurring with two of the contractions. Which of the following findings should
,the nurse report to the provider?
a. Reactive
b. Nonreactive
c. Positive
d. Negative
c. Positive
Indicates an adverse reaction by the fetus and should be reported to the provider
A nurse is providing family planning education to a client who has decided to
use a diaphragm. Which of the following should the nurse include in the plan
of care?
a. You should replace the diaphragm every 3 years
b. You should leave the diaphragm in place for at least 6 hours after
intercourse
c. You should use an oil based product as a lubricant when inserting the
diaphragm
d. You should insert the diaphragm when your bladder is full
b. You should leave the diaphragm in place for at least 6 hours after intercourse
A nurse is admitting a client who is in labor. The client admits to recent
cocaine use. For which of the following complications should the nurse
assess?
a. Abruptio placenta
b. Placenta previa
c. Preeclampsia
d. Maternal bradycardia
a. Abruptio placenta
Cocaine increases the risk for vasoconstriction and possible abruptio placenta
A nurse is providing dietary teaching to a client who has hyperemesis
gravidarum. Which of the following statements by the client indicates an
understanding of the teaching?
, a. I should eat to taste instead of trying to balance my meals
b. I will avoid having a snack at bedtime
c. I will have 8 oz of hot tea with each meal
d. I should pair my sweets with a starch instead of eating them alone
a. I should eat to taste instead of trying to balance my meals
Eat to taste to avoid nausea
A nurse is caring for a client who is in active labor and reports back pain. The
nurse performs a vaginal exam and determines the client is 8cm dilated, 100%
effaced, and -2 station. The fetus is in the occiput posterior position. Which of
the following is an appropriate intervention?
a. Perform effleurage during contractions
b. Place the client in lithotomy position
c. Assist the client to the hands and knees position
d. Apply a fetal scalp electrode
c. Assist the client to the hands and knees position
Helps relieve back pain and help the fetus rotate
A nurse is assessing a client during a weekly prenatal visit that is at 38 weeks
of gestation. Which of the following client findings should the nurse report to
the provider?
a. Blood pressure 136/88
b. Report of insomnia
c. Weight gain of 2.2 kg
d. Report of Braxton-Hicks contractions
c. Weight gain of 2.2 kg
Above the expected reference range and could indicate complications
A nurse is caring for a client who is pregnant and has epilepsy. The nurse
observes the client having a seizure. After turning the client's head to one
side, which of the following actions should the nurse take next?
ANSWERS 100% VERIFIED
A two year old child with heart failure (HF) is admitted for replacement of a
graft for coarctation of the aorta. Prior to administering the next dose of
digoxin (Lanoxin) the nurse obtains an apical heart rate of 128 bpm. What
action should the nurse implement?
a. Determine the pulse deficit
b. Administer the scheduled dose
c. Calculate the safe dose range
d. Review the serum digoxin level
b. Administer the scheduled dose
Which nursing intervention is most important to include in the plan of care for
a child with acute glomerulonephritis?
a. Encourage fluid intake
b. Promote complete bed rest
c. Weight the child daily
d. Administer vitamin supplements
c. Weight the child daily
A 7 year old child is admitted to the hospital with acute glomerulonephritis
(AGN). When obtaining the nursing history, which finding should the nurse
expect to obtain?
a. High blood cholesterol level on routine screening
b. Increased thirst and urination
c. A recent strep throat infection
d. A recent DPT immunization
c. A recent strep throat infection
,A child with leukemia is admitted for Chemotherapy with a nursing diagnosis
of "altered nutrition, less than body requirements related to anorexia, nausea
and vomiting". Which intervention should the nurse include in this child plan
of care?
Allow the child to eat any food desired and tolerated.
A client delivers a viable infant, but begins to have excessive uncontrolled
vaginal bleeding after the IV Pitocin is infused. When notifying the healthcare
provider of the condition, what information is most important for the nurse to
provide?
Maternal blood pressure
A new mother is having trouble breast feeding her newborn son. He is making
frantic rooting motions and will not grasp the nipple. What intervention would
be most helpful to this mother?
Ask the mother to stop the feeding, comfort the infant, and then assist the mother to
help the baby latch on.
A blind little girl, 8 years old was admitted to the hospital. What should be
brought to help comfort her during her hospital stay?
Bring familiar toys from home such as bear, doll.
What helps relieve pain associated with mastitis?
Ice packs
A nurse is admitting a client to the labor and delivery unit when the client
states, "my water just broke", which of the following is the priority intervention
for the nurse to take?
a. Perform Nitrazine testing
b. Assess the amniotic fluid
c. Check cervical dilation
d. Monitor the fetal heart rate
d. Monitor the fetal heart rate
Rupture of the membranes places the fetus at risk for umbilical cord prolapse.
A nurse is caring for a client undergoing an oxytocin-stimulated contraction
test. The nurse notes three contractions in 10 min with late decelerations
occurring with two of the contractions. Which of the following findings should
,the nurse report to the provider?
a. Reactive
b. Nonreactive
c. Positive
d. Negative
c. Positive
Indicates an adverse reaction by the fetus and should be reported to the provider
A nurse is providing family planning education to a client who has decided to
use a diaphragm. Which of the following should the nurse include in the plan
of care?
a. You should replace the diaphragm every 3 years
b. You should leave the diaphragm in place for at least 6 hours after
intercourse
c. You should use an oil based product as a lubricant when inserting the
diaphragm
d. You should insert the diaphragm when your bladder is full
b. You should leave the diaphragm in place for at least 6 hours after intercourse
A nurse is admitting a client who is in labor. The client admits to recent
cocaine use. For which of the following complications should the nurse
assess?
a. Abruptio placenta
b. Placenta previa
c. Preeclampsia
d. Maternal bradycardia
a. Abruptio placenta
Cocaine increases the risk for vasoconstriction and possible abruptio placenta
A nurse is providing dietary teaching to a client who has hyperemesis
gravidarum. Which of the following statements by the client indicates an
understanding of the teaching?
, a. I should eat to taste instead of trying to balance my meals
b. I will avoid having a snack at bedtime
c. I will have 8 oz of hot tea with each meal
d. I should pair my sweets with a starch instead of eating them alone
a. I should eat to taste instead of trying to balance my meals
Eat to taste to avoid nausea
A nurse is caring for a client who is in active labor and reports back pain. The
nurse performs a vaginal exam and determines the client is 8cm dilated, 100%
effaced, and -2 station. The fetus is in the occiput posterior position. Which of
the following is an appropriate intervention?
a. Perform effleurage during contractions
b. Place the client in lithotomy position
c. Assist the client to the hands and knees position
d. Apply a fetal scalp electrode
c. Assist the client to the hands and knees position
Helps relieve back pain and help the fetus rotate
A nurse is assessing a client during a weekly prenatal visit that is at 38 weeks
of gestation. Which of the following client findings should the nurse report to
the provider?
a. Blood pressure 136/88
b. Report of insomnia
c. Weight gain of 2.2 kg
d. Report of Braxton-Hicks contractions
c. Weight gain of 2.2 kg
Above the expected reference range and could indicate complications
A nurse is caring for a client who is pregnant and has epilepsy. The nurse
observes the client having a seizure. After turning the client's head to one
side, which of the following actions should the nurse take next?
