HESI PN MATERNITY HESI PN MATERNAL NEWBORN

• | P a g e

HESI PN MATERNITY /HESI PN MATERNAL NEWBORN

ACTUAL EXAM 3 VERSIONS AND STUDY GUIDE

COMPLETE 600 QUESTIONS WITH DETAILED

VERIFIED ANSWERS /ALREADY GRADED A+

//LATEST EXAM!!!

During stage two of labor, what assessments must the labor nurse perform? (Select all that apply.)

• Fetal heart rate before the contraction
• Fetal heart rate during the contraction
• Fetal heart rate after the contraction
• Frequency of contractions
• Duration of contractions
• Uterine tone between contractions - Answer-A, B, C, D,

E, F

The nurse must assess the fetal heart rate before, during and after the contractions to determine the fetal response to the contractions. Frequency may slow during the second stage. Duration will help facilitate decent of the presenting part. The uterine tone between contractions 1 / 4

• | P a g e

should be soft to facilitate placental filling after the contraction.

A 41-week multigravida is receiving oxytocin to augment labor. Contractions are firm and occurring every 5 minutes, with a 30- to 40-second duration. The fetal heart rate increases with each contraction and returns to baseline after the contraction. What is the next nursing action?

• Place a wedge under the client's left side.
• Determine cervical dilation and effacement.
• Administer 10 L of oxygen via facemask.
• Increase the rate of the oxytocin infusion. - Answer-D.

Increase the rate of the oxytocin infusion.

The goal of labor augmentation is to produce firm contractions that occur every 2 to 3 minutes, with a duration of 60 to 70 seconds, and without evidence of fetal stress. FHR accelerations are a normal response to contractions, so the oxytocin (Pitocin) infusion should be increased per protocol to stimulate the frequency and intensity of contractions. Options A and C are indicated for fetal stress. A sterile vaginal examination places the client at risk for infection and should be performed when the 2 / 4

• | P a g e

client exhibits signs of progressing labor, which is not indicated at this time.

The nurse is teaching a prenatal class about the structure of the pelvis and is using a model of a pelvis in the presentation. Which statements will the nurse include in the teaching plan? (Select all that apply.)

• "The baby has to pass through the true pelvis."
• "The pelvis consists of three distinct features."
• "The true pelvis is below the pelvic brim."
• "The ischial spines determine how low the baby is

located."

• "The shape of the pelvis does not impact the labor

process." - Answer-A, B, C, D

A gynecoid shape pelvis is the most favorable for birthing.The remaining statements are true.

A 38-week primigravida works as an office assistant and sits at a computer 8 hours each day. She tells the nurse that her feet have begun to swell. Which instruction will aid 3 / 4

• | P a g e

in the prevention of pooling of blood in the lower extremities?

A.Wear support stockings.

• Reduce salt in the diet.
• Move about every hour.
• Avoid constrictive clothing. - Answer-C. Move about

every hour.

Pooling of blood in the lower extremities results from the enlarged uterus exerting pressure on the pelvic veins.Moving about every hour will relieve pressure on the pelvic veins and increase venous return. Option A would increase venous return from varicose veins in the lower extremities but would be of little help with swelling. Option B might be helpful with generalized edema but is not specific for edematous lower extremities. Option D does not address venous return, and there is no indication in the question that constrictive clothing is a problem.

In developing a teaching plan for expectant parents, the nurse decides to include information about when the parents can expect the infant's fontanels to close. Which statement is accurate regarding the timing of closure of an

• / 4