HESI Pregnancy, Labor, Childbirth, and Postpartum Real Exam With Answers (116 Solved Questions)

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NEW GENERATION COMPREHENSIVE HESI EXAMS FOR PREGNANCY,LABOR, CHILDBIRTH, AND POSTPARTUM | REAL EXAMS WITHRATIONALEWhich action provides support for the fetal head as it is being delivered?Applying suprapubic pressurePlacing a hand firmly against the perineumDistributing the fingers evenly around the headMaintaining pressure against the anterior fontanelRationaleDistribution of the fingers around the head will prevent a rapid change in intracranial pressure while thehead is being born and keeps the head from 'popping out,' which could result in maternal perinealtrauma. Applying suprapubic pressure will not aid in the birth of the head. Placing a hand firmlyagainstthe perineum may interfere with the birth and harm the neonate.Maintaining pressure against the anterior fontanel could injure the neonate.Between contractions that are 2 to 3 minutes apart and last about 45 seconds the internal fetal monitorshows a fetal heart rate (FHR) of 100 beats/min. Which is the priority nursing action?Notify the health care provider.Resume continuous fetal heart monitoring.Continue to monitor the maternal vital signs.Document the fetal heart rate as an expected response to contractions.

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RationaleThe expected FHR is 110 to 160 beats/min between contractions. An FHR of 100 beats/min isbradycardia (baseline FHR slower than 110 beats/min) and indicates that the fetus may becompromised, requiring notifying the health care provider and medical intervention. Resumingcontinuous fetal heart monitoring may be dangerous. The fetus may be compromised, and time shouldnot be spent on monitoring. Continuing to monitor the maternal vital signs is not the priority at thistime. Although a fetal heart rate slower than 110 beats/minute should be documented, it is not anexpected response.Test-Taking Tip: Work with a study group to create and take practice tests. Think of the kinds of questionsyou would ask if you were composing the test. Consider what would be a good question, what would bethe right answer, and what other answers might appear right but would in fact be incorrect.Which physiological alteration does the nurse expect in a client's hematological system during the secondtrimester of pregnancy?An increase in hematocritAn increase in blood volumeA decrease in sedimentation rateA decrease in white blood cells (WBCs)RationaleThe blood volume increases by approximately 50% during pregnancy. Peakblood volume occursbetween 30 and 34 weeks' gestation. The hematocrit decreases as a result of hemodilution. Thesedimentation rate increases

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because of a decrease in plasma proteins. WBCs count increases somewhat starting in the secondtrimester and peak in the third. WBCs are in the 5000 to 15,000 range during pregnancy.Which factor accounts for the greatest portion of weight gain during pregnancy?Fetal growthFluid retentionMetabolic alterationsIncreased blood volumeRationaleWeight gain during pregnancy averages 25 to 35 lb (11.3–15.9 kg). Of this amount, the fetus accounts for7 to 8 lb (3.2–3.6 kg), or approximately 30%. Fluid retention accounts for 20% to 25% of weight gain.Metabolic alterations do not cause weight gain. Increased blood volume accounts for 12% to 16% ofweight gain.Correct (113)Morning sickness generally disappears by the end of which month?Fifth monthThird month

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Fourth monthSecond monthRationaleBecause of a decrease in chorionic gonadotropin, morning sickness seldom persists beyond the firsttrimester. Morning sickness usually ends at the end of the third month, not the second month, whenthe chorionic gonadotropin level falls. It is still present in the second month because of the high level ofchorionic gonadotropin but has usually diminished by the fifth month.Which information would the nurse include in the discharge teaching of a postpartum client?The prenatal Kegel tightening exercises should be continued.A bowel movement may not occur for up to a week after the birth.The episiotomy sutures will be removed at the first postpartum visit.A postpartum checkup should be scheduled as soon as menses returns.RationaleKegel exercises may be resumed immediately and should be done for the restof the client's lifebecause they help strengthen muscles needed for urinary continence and may enhance sexualintercourse. Episiotomy sutures do not have to be removed. Bowel movements should spontaneouslyreturn in 2 to 3 days after the client gives birth; a delay of bowel movements promotes

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constipation, perineal discomfort, and trauma. The usual postpartum examination is 6 weeks after birth;the menses may return earlier or later than this and should not be a factor when the client is scheduling apostpartum examination.Test-Taking Tip: Pace yourself when taking practice quizzes. Because most nursing exams have specifiedtime limits, you should pace yourself during the practice testing period accordingly. It is helpful toestimate the time that can be spent on each item and still complete the examination in the allotted time.You can obtain this figure by dividing the testing time by the number of itemson the test. For example, a1-hour (60-minute) testing period with 50 items averages 1.2 minutes per question. The NCLEX exam isnot a timed test. Both the number of questions and the time to complete the test vary according toeach candidate's performance. However, if the test-taker uses the maximum of 5 hours to answer themaximum of 265 questions, each question equals 1.3 minutes.Which response would the nurse give to a postpartum client who asks if she can drink a small glass of winebefore breast-feeding the first time to help her relax?'I think drinking 1 glass of wine won't be a problem. Go ahead.''You seem a little tense. Tell me how you feel about breast-feeding.''You seem to find it relaxing, but you should try to find another way torelax.''I think drinking 1 glass of wine is alright, but you had better checkwith your health careprovider first.'

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RationaleStating that the client seems tense and initiating a discussion honors the client's feelings and encouragesexpression of them; there is no reference to alcohol consumption and its relaxing eûects. Alcoholingestion should not be encouraged, because it enters the breast milk. Stating that the client needs tofind another way to relax reflects the client's statement but not her underlyingfeelings. Suggesting that shefind another way to relax may make the client defensive and shut oû communication. Although alcoholingestion should not be encouraged because it enters breast milk, the primary health care providerneed not be involved because health education is within the role of the nurse.Which statement by a breast-feeding mother indicates that thenurse's teaching regarding stimulatingthe let-down reflex has been successful?'I will take a cool shower before each feeding.''I will drink a couple of quarts of fat-free milk a day.''I will wear a snug-fitting breast binder day and night.''I will apply warm packs and massage my breasts before each feeding.'RationaleApplying warm packs and massaging the breasts before each feeding help dilate milk ducts, promoteemptying of the breasts, and stimulate further lactation. Taking a cool shower before each feeding willcontract the milk ducts and interfere with the let-down reflex. Heavy consumption of milk products isnotrequired to stimulate the production of milk. Breast binders may inhibit lactation by fooling the bodyinto thinking that milk secretion is no longer

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needed.A nonstress test (NST) is scheduled for a client with mild preeclampsia. During an NST, the client askswhat it means whenthe fetal heart rate goes up every time the fetus moves. Which isan appropriateresponse?'These accelerations are a sign of fetal well-being.''These accelerations indicate fetal head compression.''Umbilical cord compression is causing these accelerations.'Uteroplacental insuûciency is causing these accelerations.'RationaleThe NST is performed before labor begins. Accelerations with movement and a baseline variability of5 to 15 beats/min indicate fetal well-being. This reactive NST is considered positive. Early decelerationsare associated with fetal head compression during a contraction stress test (CST) or during labor.Variable decelerations are associated with cord compression during a CST or during labor. Latedecelerations during a CST or during labor are associated with uteroplacental insuûciency.Which descriptor would the nurse use when explaining to a clienthow to time the frequency ofcontractions?From the end of 1 contraction to the end of the next contractionFrom the end of 1 contraction to the beginning of the next contraction

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From the beginning of 1 contraction to the end of the next contractionFrom the beginning of 1 contraction to the beginning of the next contractionRationaleThe frequency of contractions is timed from the beginning of 1 contraction to the beginning of the next;this is the definition of 1 contraction cycle. The beginning, not the end, of a contraction is the startingpoint for timing the frequency of contractions. The time between the end of 1 contraction and thebeginning of the next contraction is the interval between contractions. Timing from the beginning of 1contraction to the end of the next contraction is too long a time frame and will produce inaccurateinformation.The first day of a client's last menstrual period was July 22. Which is the estimated date of birth (EDB)?May 7April 29April 22March 6RationaleHer EDB is April 29. Naegele's rule is an indirect, noninvasive method for estimating the date of birth:EDB = last menstrual period + 1 year – 3 months

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+ 7 days. May 7 is beyond the EDB. April 22 and March 6 are both before theEDB.A client who is at 20 weeks' gestation visits the prenatal clinic for the first time. Assessment revealstemperature of 98.8°F (37.1°C),pulse of 80 beats per minute, blood pressure of 128/80 mm Hg, weightof 142 lb (64.4 kg) (prepregnancy weight was 132 lb [59.9 kg]), fetal heart rate (FHR) of 140 beats perminute, urine that isnegative for protein, and fasting blood glucose level of 92 mg/dL (5.2 mmol/L). Whichwould the nurse do after making these assessments?Report the findings because the client needs immediate intervention.Document the results because they are expected at 20 weeks'gestation.Record the findings in the medical record because they are not withinthe norm but are notcritical.Prepare the client for an emergency admission because these findingsmay representjeopardy to the client and fetus.RationaleAll data presented are expected for a client at 20 weeks' gestation and should be documented. Thereis no need for immediate intervention or an emergencyadmission because all findings are expected.A prenatal client's vaginal mucosa is noted to have a purplish

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discoloration. Which sign would be documented in the client'sclinical record?HegarGoodellChadwickBraxton-HicksRationaleA purplish coloration, called the Chadwick sign, results from the increased vascularity and bloodvessel engorgement of the vagina. The Hegar sign is softening of the lower uterine segment. TheGoodell sign is softening of thecervix. After the fourth month of pregnancy, irregular, painless uterinecontractions, called Braxton-Hicks contractions, can be felt through the abdominal wall.Test-Taking Tip: The following are crucial requisites for doing well on the NCLEX exam: (1) a soundunderstanding of the subject; (2) the ability to follow explicitly the directions given at the beginning ofthe test; (3) the ability to comprehend what is read; (4) the patience to read each question and set ofoptions carefully before deciding how to answer the question; (5) the ability to use the computercorrectly to record answers; (6) the determination to do well;and (7) a degree of confidence.When a client at 39 weeks' gestation arrives at the birthing suiteshe says, 'I've been havingcontractions for 3 hours, and I think my water broke.' Which action would the nurse take to confirm

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that the membranes have ruptured?Take the client's oral temperature.Test the leaking fluid with nitrazine paper.Obtain a clean-catch urine specimen.Inspect the perineum for leaking fluid.RationaleNitrazine paper will turn dark blue if amniotic fluid is present; it remains the same color in the presenceof urine. Temperature assessment is not specific toruptured membranes at this time; vital signs are partof the initial assessment.Although this may be done as part of the initial assessment, a urine test isunrelated to leakage of amniotic fluid. Inspecting the perineum for leaking fluid will not confirm ruptureof the membranes.At which point during a human pregnancy does the embryobecome a fetus?During the 8th week of the pregnancyAt the end of the 2nd week of pregnancyWhen the fertilized egg becomes implantedWhen the products of conception are seen on the ultrasoundRationaleDuring the 8th week of pregnancy the organ systems and other structures are

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developed to the extent that they take the human form; at this time the embryo becomes a fetus andremains so until birth. At the end of the 2nd week of pregnancy, the developing cells are called anembryo. At the time of implantation, the group of developing cells is called a blastocyst. The embryocan be visualized on ultrasound before it becomes a fetus.Which technique would the nurse suggest to a laboring woman's partner that involves gently stroking thewoman's abdomen in rhythm with her breathing during a contraction?MassageEüeurageAcupressureCounterpressureRationaleEüeurage is the gentle stroking of the abdomen in rhythm with her breathingduring a contraction.Massage is the application of therapeutic touch and pressure on the body. Acupressure is theapplication of pressure along special acupressure points. Counterpressure is the application of pressureto the sacrum during a contraction.A primigravida who is at 40weeks' gestationarrivesatthe birthing center with abdominal crampingand a bloody show. Her membranes ruptured 30 minutes before arrival. A vaginal examination reveals 1cm of dilation and the presenting part at -1

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station. Which action would the nurse take after obtaining thefetal heart rate and maternal vitalsigns?Teach the client how to push with each contraction.Provide the client with comfort measures for relaxation.Prepare to have the client's blood typed and cross-matched.Encourage the client to perform patterned, paced breathing.RationaleThe client is experiencing the expected discomforts of labor; the nurse should initiate measures thatwill promote relaxation. The client is in early first-stage labor; pushing commences during the secondstage. There is no evidence that the client's bleeding is excessive or unexpected and that atransfusion will be needed. Patterned, paced breathing should be used in the transition phase, notthe early phase of the first stage of labor.Test-Taking Tip: Answer every question. A question without an answer isalways a wrong answer,so go ahead and guess.Which is the nurse's first action when a client in active labor starts screaming, 'The baby iscoming! Do something!'?Notify the practitioner of the imminent birth.Tell the client that it is too soon and encourage her to pant.Check the perineal area for visibility of the presenting part.Help the client hold her knees together and explain what to expect.

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RationaleThe first action by the nurse would be to confirm whether birth is imminent by checking the perineal areato determine whether the presenting part is emerging. Confirming the client's sensation is the priority;the nurse would remain with the client and ask a colleague to call the practitioner if birth is imminent.Stating that birth is not imminent demeans the client, and she may be correct. Holding the kneestogether is contraindicated. If birth is imminent, this could cause injury to the fetus, and if it is notimminent, this position is uncomfortable and unnecessary.Which complication is prevented by coaching a client in the second stage of labor to take a breath atleast every 6 seconds while pushing with each contraction?Fetal hypoxiaPerineal lacerationsCarpopedal spasmsMaternal hypertensionRationaleProlonged breath holding at this stage of labor can result in decreased placental/fetal oxygenation,which could lead to fetal hypoxia. Perineal lacerations occur with rapid, uncontrolled expulsion ofthe fetus. Carpopedalspasms and maternal hypertension are not caused by prolonged holding ofthe breath.

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Test-Taking Tip: If the question asks for an immediate action or response, all the answers may becorrect, so base your selection on identified priorities for action.Which immediate action would the nurse take if a client in theactive phase of labor says, 'I feel allwet. I think I wet myself.'?Give her the bedpan.Change the bed linens.Inspect her perineum.Take an oral temperature.RationaleInspection of the perineum is performed to determine whether rupture of themembranes has occurredand whether the umbilical cord has prolapsed.Giving the client the bedpan is not a priority. Changing the bed linens is not the priority, although it isdone eventually if the membranes have ruptured. An oral temperature should be taken after it has beenestablished that the membranes have ruptured.Which client statement indicates understanding of teachingabout a nonstress test?'I'll need to have an intravenous (IV) line so the medication can be injected before the test.''My baby may get very restless after I have this test.''I hope this test doesn't cause my labor to start too early.'

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