HESI RN Maternity Exam

HESI RN Maternity Exam

VERSION 6

• The nurse is planning care for a client at 30-weeks gestation who is

experiencing preterm labor.· Terbutaline (Brethine) 0.25 mg subcutaneously q15 minutes x 3 · Ampicillin 1 gram IV push q8h.· Betamethasone (Celestone) 12 mg deep IM · Butorphanol (Stadol) 1 mg IV push q2h PRN pain

• A pregnant woman in the first trimester of pregnancy has hemoglobin of 8.6

mg/dl and a hematocrit of 25.1 %. What food should the nurse encourage this client to include in her diet?· Carrots · Chicken · Yogurt · Cheese

• The nurse is preparing to administer methylergonovine maleate (Methergine) to

a postpartum client. Based on what assessment finding should the nurse withhold the drug?· Respiratory rate of 22 breaths/min · A large amount of lochia rubra · Blood pressure 149/90 · Positive Homan’s sign

• A client receiving oxytocin (Pitocin) to augment early labor. Which assessment

is most important for the nurse to obtain each time the infusion rate is increased?· Pain level · Blood pressure · Infusion site · Contraction pattern

• One day after vaginal delivery of a full term baby, a postpartum client’s white

blood cell count is 15.000/mm. What action should the nurse take first?· Check the differential, since the WBC is normal for this client · Assess the client’s temperature, pulse, and respirations q4h · Assess the client’s perineal area for signs of a perineal hematoma · Notify the healthcare provider, since this finding is indicative of infection 1 / 2

• A neonate who has congenital adrenal hypoplasia (CAH) presents with

ambiguous genitalia. What is the primary nursing consideration when supporting the parents of a child with this anomaly?· Discuss the need for cortisol and aldosterone replacement therapy after discharge · Support the parents in their decision to assign sex of their child according to their preference · Offer information about ultrasonography and genotyping to determine sex assignment · Explain that corrective surgical procedures consistent with sex assignment can be delayed

• A loading dose of terbutaline (Brethine) 250 mcg IV is prescribed for a client in

preterm labor. Brethine 20 mg is added to 1,000 ml D W. How many ml of the solution should the nurse administer?13

• A 36-week primigravida is admitted to labor and delivery with severe

abdominal pain and bright red vaginal bleeding. Her abdomen is rigid and tender to touch. The fetal heart rate FHR) is 90 beats/minute, and the maternal heart rate is 120 beats/minute. What action should the nurse implement first?· Alert the neonatal team and prepare for neonatal resuscitation · Notify the healthcare provider from the client’s bedside · Obtain written consent for an emergency cesarean section · Draw a blood sample for stat hemoglobin and hematocrit

• A laboring client’s membranes rupture spontaneously. The nurse notices that the

amniotic fluid is greenish-brown. What intervention should the nurse implement first?· Turn the client to her left side · Contact the healthcare provider · Assess the fetal heart rate · Check the cervical dilation

• A client whose labor is being augmented with an oxytocin(Pitocin) infusion

requests an epidural for pain control. Findings of the last vaginal exam performed

• hour ago, were 3 cm cervical dilation, 60% effacement, and a 2-station. What

action should the nurse implement first?· Decrease the oxytocin infusion rate · Determine current cervical dilation

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