HESI Prenatal OB Practice Exam With Answers (108 Solved Questions)

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OB HESI PRACTICE EXAM WITHRATIONALEWhat nursing action should be implemented when intermittently gavage-feeding apreterm infant?Allow formula to flow by gravity.Avoid letting infant suck on tube.Insert feeding tube through nares.Apply steady pressure to syringe.RationaleGavage feeding is commonly used to feed preterm infants who are born at lessthan 32-weeks gestation, infants who weigh less than 1500 grams, or infants whoare unable to tolerate oral feedings. The feeding should flow by gravity (A) toavoid over-distention and a sudden sensation of fullness that may causevomiting. Allowing the infant to suck on the tube, not (B), permits observation ofthe sucking response. The feeding tube should be inserted orally, since nasalinsertion (C) impedes obligatory nose breathing and may irritate delicate nasalmucosa. (D) can result in vomiting if the rate of administration is too fast.A client is receiving an oxytocin infusion for induction of labor. When the clientbegins active labor, the fetal heart rate (FHR) slows at the onset of severalcontractions with subsequent return to baseline before each contraction ends.What action should the nurse implement?Insert an internal monitor device.Change the woman's position.Discontinue the oxytocin infusion.Document the finding in the client record.RationaleEarly FHR decelerations are a normal finding during active labor that occurs dueto fetal head compression, so the finding should be documented in the clientrecord (D). Although the client's status should be monitored continuously, this isa reassuring FHR pattern, so (A, B, and C) are not indicated.The nurse is teaching a new mother about diet and breastfeeding. Whichinstruction is most important to include in the teaching plan?Avoid alcohol because it is excreted in breast milk.Avoid spicy foods to prevent infant colic.Increase caloric intake by approximately 500 calories/day.Double prenatal milk intake to improve Vitamin D transfer to the infant.RationaleAlcohol should be avoided while breastfeeding because, when consumed by themother, it is excreted in breast milk (A). It also adversely effects the milk ejectionreflex. While (B) may cause some gastric upset in some babies, it does not causecolic. (C) should also be included in diet teaching for a breastfeeding mother, butbecause it does not involve safety to the infant it does not have the same degreeof importance as (A). Recent research has shown that infants receive very littleVitamin D via the breastmilk and some sources recommend Vitamin Dsupplementation in exclusively breastfed babies to prevent rickets.

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An infant born at 37-weeks gestation, weighing 4.1 kg (9.02 pounds) is 2 hoursold and appears large for gestational age, flushed, and tremulous. Whatprocedure should the nurse follow to implement a glucose screening? (Arrangethe examination process from first on top to last on the bottom.)CorrectAnswer:•1.Wrap the infant's foot with a heel warmer for 5 minutes.•2.Collect a spring-loaded automatic puncture device.•3.Restrain the newborn's foot with your free hand.•4.Cleanse puncture site on the lateral aspect of the heel.RationaleObtaining capillary blood for the glucose screening for a infant that ismacrosomic and at risk for hypoglycemia should begin with wrapping the infant'sfoot with a heel warmer for 5 to 10 minutes to facilitate vasodilation to obtain anadequate blood sample volume. Next, a spring loaded automatic puncture deviceshould be obtained to puncture the skin because it is less traumatic than amanual lancet. Then, the nurse's hand is used to restrain the foot as the puncturesite on the lateral aspect of the heel is cleansed.The nurse observes a male newborn who is displaying a rigid posture with hiseyes tightly closed and grimacing as he is crying after an invasive procedure. Thebaby's blood pressure is elevated on the Dinamap display. What action shouldthe nurse implement?Obtain a serum glucose level.Give the infant medication for pain.Feedthenewborn1ounceofformula.Requestageneticconsultation.RationaleA cry face (or crying with the eyes squeezed or closed tightly), a rigid posture,and an increase in blood pressure are indicative of pain in the neonate, soanalgesia should be given for pain (B). The symptoms of hypoglycemia (A) arejitteriness and mottling. The signs of hunger include rooting, tongue extrusion

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and possibly crying (C). A high-pitched shrill cry is associated with neurologicand genetic anomalies (D).The nurse assesses a high-risk neonate under a radiant warmer who has anumbilical catheter and identifies that the neonate's feet are blanched. Whatnursing action should be implemented?Place socks on infant.Elevate feet 15 degrees.Wrap feet loosely in prewarmed blanket.Report findings to the healthcare provider.RationaleVasoconstriction of peripheral vessels, which can seriously impair circulation, istriggered by arterial vasospasm caused by the presence of the catheter, theinfusion of fluids, or the injection of medication. Blanching of the buttocks,genitalia, or the legs or feet is an indication of vasospasm and should be reportedimmediately to the healthcare provider (D). (A, B, and C) do not provide effectiveresolution of this potentially serious complications.A gravid client develops maternal hypotension following regional anesthesia.What intervention(s) should the nurse implement? (Select all that apply.)Select all that applySome correct answers were not selectedAdminister oxygen.IncreaseIVfluids.Perform a vaginal examination.Assist client to a sitting position.Placetheclientinalateralposition.Monitorfetal status.RationaleCorrect selections are (A, B, E, and F). Oxygen (A), fluids (B), lateral position (E),and evaluating fetal response (F) effectively manage maternal hypotensionfollowing regional anesthesia. Placing the client in a sitting position (D) does notfacilitate venous return to the heart and limits perfusion of the fetus. A sterilevaginal examination (C) does not increase blood flow and oxygenation to theplacenta and fetus.A newborn infant who is 24-hours-old is on a 4-hour feeding schedule of formula.To meet daily caloric needs, how many ounces are recommended at eachfeeding?2 ounces.4 ounces.1.5 ounces.3.5 ounces.RationaleA newborn requires approximately 19 to 21 ounces of formula each day (sixfeedings per 24-hour period x 3.5 = 21). One-and-a-half to two ounces (A and C)

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may be insufficient to meet the newborn's calorie needs. (B) may cause the infantto spit-up due to over-feeding.A client at 28-weeks gestation arrives at the labor and delivery unit with acomplaint of bright red, painless vaginal bleeding. For which diagnosticprocedure should the nurse prepare the client?Contraction stress test.Internal fetal monitoring.Abdominal ultrasound.Lecithin-sphingomyelin ratio.RationaleBright red, painless vaginal bleeding occuring after 20-weeks gestation can be anindicator of placenta previa, which is confirmed by abdominal ultrasound (C). (A,B and D) are invasive procedures that increase the risk for premature onset oflabor, and are not indicated at this client's gestation.A primigravida at 12-weeks gestation who just moved to the United Statesindicates she has not received any immunizations. Which immunization(s) shouldthe nurse administer at this time? (Select all that apply.)Select all that applySome correct answers were not selectedTetanus.Rubella.Diphtheria.Chickenpox.Hepatitis B.RationaleCorrect selections are (A, C, and E). Vaccines composed of killed viruses may beadministered during pregnancy. Rubella (B) and chickenpox (D) consist of live orattenuated live viruses which would be contraindicated during pregnancy due topotential teratogenicity.A client in labor receives an epidural block. What intervention should the nurseimplement first?Encourage oral fluids.Assess contractions.Monitor blood pressure.Obtain a radial pulse.RationaleThe risk for maternal hypotension is commonly increased by an epidural, soblood pressure should be monitored immediately after the first epidural dose (C)and for 15 minutes thereafter. Oral fluids should be encouraged to help keep theclient hydrated (A), but the first action is to evaluate the client for side effects ofthe epidural block. Although (B and D) should be continuously monitored after anepidural, the first objective sign of epidural precipitated vasodilation ishypotension.

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A client at 8-weeks gestation ask the nurse about the risk for a congenital heartdefect (CHD) in her baby. Which response best explains when a CHD may occur?It depends on what the causative factors are for a CHD.We don't really know what or when CHDs occur.They usually occur in the first trimester of pregnancy.Theheartdevelopsinthethirdtofifthweeksafterconception.RationaleThe cardiovascular system is the first organ system to develop and function inthe embryo. The blood vessel and blood formation begin in the third week, andthe heart is developmentally complete in the fifth week (D). Regardless of theetiological factor, the heart is vulnerable during its period of development -- thethird to fifth weeks. (A, B, and C) are inaccurate.A primigravida at 12-weeks gestation tells the nurse that she does not like diaryproducts. Which food should the nurse recommend to increase the client'scalcium intake?Canned clams.Fresh apricots.Cannedsardines.Spaghetti with meat sauce.RationaleA 3 ounce can of sardines (with bones) provides about the same amount ofcalcium as 1 cup of milk (C). (A, B, and D) are not good sources for dietarycalcium.When discussing birth in a home setting with a group of pregnant women, whichsituation should the nurse include about the safety of a home birth?Only the woman and her midwife should be present during the delivery.The woman should live no more than 15 minutes from the hospital.The woman's extended family should be allowed to attend the home birth.Medical backup should be available quickly in case of complications.RationaleAccess to quick emergency care should be available in the event that anunforeseen complication arises (D) during a home birth. Although the nurse-midwife should be a competent healthcare provider during a home birth (A),access to emergency, surgical, and resuscitation assistance should be readilyavailable. A 15-minute drive to the hospital is ideal, but (B) does not ensure thesafest situation. The presence and support of family during the home birth (C)does not necessarily ensure a safe home birth.Which statement by a client who is pregnant indicates to the nurse anunderstanding of the role of protein during pregnancy?

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"ProteinhelpsthefetusgrowwhileIampregnant.""Gestational diabetes is prevented by eating protein.""Anemiaisavertedbyconsumingenoughprotein.""My baby will develop strong teeth after he is born."RationaleAdequate protein intake is essential to meet increasing demands of rapid growthof the fetus (A) and maternal changes during pregnancy, such as enlargement ofthe uterus, mammary glands, and placenta, increase in the maternal bloodvolume, and formation of amniotic fluid. Protein is essential for anabolism, but itsconsumption does not prevent gestational diabetes (B). Iron found in high proteinfoods, such as meat, helps prevent anemia (C), but the basic need for protein isthe anabolic growth processes of the fetus. Although calcium is needed for fetalbone and teeth development (D), it is not found in all protein food sources.The nurse is assessing a full-term newborn’s breathing pattern. Which findingsshould the nurse assess further? (Select all that apply.)Select all that applyShallow with an irregular rhythm.Chest breathing with nasal flaring.Diaphragmatic with chest retraction.Abdominal with synchronous chest movements.Heart rate of 158 beats per minute.Gruntingheardwithastethoscope.RationaleBreathing with nasal flaring, diaphragmatic breathing with chest retraction, andgrunting are signs of respiratory distress in the infant.A client is experiencing "back" labor and complains of intense pain in the lowerlumbar-sacral area. What action should the nurse implement?Perform effleurage on the abdomen.Encourage pant-blow breathing techniques.Apply counter pressure against the sacrum.Assist the client in guided imagery.RationaleCounter pressure against the sacrum (C) during contractions often providessignificant relief for "back labor," which results from occipital posterior position.Effleurage (A) is a helpful distraction strategy many clients use duringcontractions but does not assist with lower back pain. Back labor can occurthroughout labor if the fetus does not rotate, and helpful distractions, such as (B),used during transition, and (D), used during phase one of labor, are not effectivefor back labor.A client at 28-weeks gestation experiences blunt abdominal trauma. Whichparameter should the nurse assess first for signs of internal hemorrhage?Vaginal bleeding.Complaints of abdominal pain.Changes in fetal heart rate patterns.Alteration in maternal blood pressure.Rationale

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Hypoperfusion of the fetus may be present before the onset of clinical signs ofmaternal compromise or shock in a pregnant woman, so the external fetalmonitor tracings should be assessed first to determine signs of fetal hypoxia dueto internal bleeding in the mother. (A, B, and D) are not the first findings ofinternal hemorrhage in the pregnant client.Which prescription should the nurse administer to a newborn to reducecomplications related to birth trauma?Silver nitrate.Erythromycin (Ilotycin ointment).Ceftriaxone (Rocephin).VitaminK(AquaMEPHYTON).RationaleThe normal neonate is vitamin K deficient, so to rapidly elevate prothrombinlevels and reduce the risk of neonatal bleeding, newborns receive a singleinjection of vitamin K (AquaMEPHYTON) (D). (A and B) are prophylacticophthalmic agents used to prevent neonatal ophthalmia. (C) is an antibiotic usedto treat neonatal infections.A multiparous client has been in labor for 8 hours when her membranes rupture.What action should the nurse implement first?Prepare the client for imminent birth.Assess the fetal heart rate and pattern.Document the characteristics of the fluid.Notify the client's primary healthcare provider.RationaleThe fetal heart rate and pattern should be assessed (B) to determine compromiseof fetal well-being caused by compression or prolapse of the umbilical cord. Theintensity and frequency of the uterine contractions often trigger spontaneousrupture of the membranes (SROM), which does not indicate that birth is imminent(A). The healthcare provider should be notified of the client and fetal well-beingafter evaluation of SROM. Although the characteristics of the amniotic fluidshould be documented (C), assessment of fetal response to the SROM is thepriority.The nurse is teaching a primigravida at 10-weeks gestation about the need toincrease her intake of folic acid. Which explanation should the nurse provide thatsupports preventative perinatal care?The risk for neonatal cerebral palsy increases with folic acid deficiencies duringpregnancy.Folic acid can significantly reduce the incidence of mental retardation.Adequate folic acid during embryogenesis reduces the incidence of neural tubedefects.The incidence of congenital heart defects is related to folic acid intake deficiencies.RationaleFolic acid can significantly reduce neural tube defects (C) if taken during earlypregnancy. (A, B, or D) are not valid explanations.

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The nurse is preparing to gavage feed a preterm infant who is receiving IVantibiotics. The infant expels a bloody stool. What nursing action should thenurse implement?Institute contact precautions.Obtain a rectal temperature.Assess for abdominal distention.Decrease the amount of the feeding.RationaleEtiological factors playing an important role in the development of necrotizingenterocolitis (NEC), a complication common in premature infants, includeintestinal ischemia, colonization by pathogenic bacteria, and substrate (formulafeeding) in the intestinal lumen. Bloody stools, abdominal distention, diarrhea,and bilious vomitus are signs of NEC. Nursing responsibilities include measuringthe abdomen (C) and listening for bowel sounds. Contact precautions (A) arenecessary if a contagious gastrointestinal infection is suspected. Rectaltemperatures are contraindicated (B) because of the risk for perforation of thebowel. Oral or gavage feeding is stopped, not (D), until necrotizing enterocolitis isruled out.A client in active labor at 39-weeks gestation tells the nurse she feels a wetsensation on the perineum. The nurse notices pale, straw-colored fluid with smallwhite particles. After reviewing the fetal monitor strip for fetal distress, whataction should the nurse implement?Escort the client to the bathroom.Offer the client a bed pan.Performanitrazinetest.Clean the perineal area.RationaleThe normal characteristic of amniotic fluid is pale, straw-colored fluid, which maycontain white flecks of vernix, with an alkaline pH, so (C) should be done toconfirm the pH of the fluid. (A or B) may be indicated if the fluid is urine. (D)should be done after determining the type of fluid expelled.The nurse is providing discharge teaching for a gravid client who is beingreleased from the hospital after placement of cerclage. Which instruction is themost important for the client to understand?Plan for a possible cesarean birth.Arrange for home uterine monitoring.Make arrangements for care at home.Reportuterinecrampingorlowbackache.RationaleUterine cramping and low back pain (D) are symptoms of preterm labor andshould be reported to the healthcare provider immediately because the cerclagemay need to be removed. A cesarean birth can be planned (A) or the cerclage canbe removed at 37-weeks gestation to prepare for a vaginal birth. Home uterine

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activity monitoring (B) is used to limit the woman’s need for visits and to safelymonitor her status at home. Bed rest is an element of care so the client shouldmake arrangements for care at home (C) and someone to do household chores.(A, B, and C) do not have the priority of (D).A multiparous client delivered a 7 lb 10 oz infant 5 hours ago. Upon fundalassessment, the nurse determines the uterus is boggy and is displaced aboveand to the right of the umbilicus. Which action should the nurse implement next?Document the color of the lochia.Observe maternal vital signs.Assist the client to the bathroom.Notify the healthcare provider.RationaleFundus displacement commonly occurs in the early hours of the postpartumperiod due to urinary retention, so assisting the client to the bathroom (C) to voidshould be implement next. (A and B) can be completed after the client's bladder isemptied. (D) should only be implemented if the fundus does not become firm orlochial bleeding continues after the bladder is emptied.Which finding in the medical history of a post-partum client should the nursewithhold the administration of a routine standing order for methylergonovinemaleate (Methergine)?Pregnancyinducedhypertension.Placenta previa.Gestational diabetes.Postpartum hemorrhage.RationaleMethergine is used for post-partum bleeding. A client's history of pregnancy-induced hypertension (A) is a contraindication for Methergine which causesvasoconstriction and increases blood pressure, so the routine standing ordershould be withheld and reported to the healthcare provider. (B, C, and D) are notcontraindications for the use of Methergine.A client in her second trimester of pregnancy asks if it is safe for her to have adrink with dinner. How should the nurse respond to the client?During second trimester beer can be consumed without harm to the fetus.Wine can be consumed several times a week after the first trimester.Only one drink with the evening meal is not harmful to the fetus.Abstinence is strongly recommended throughout the pregnancy.RationaleA safe level of alcohol consumption during pregnancy has not yet beenestablished, so although the consumption of occasional alcoholic beverages maynot be harmful to the mother or her developing fetus, complete abstinence isstrongly advised (D). Beer (A), wine (B) or any alcoholic drink (C) consumption isnot recommended during the pregnancy.The nurse assesses a male newborn and determines that he has the followingvital signs: axillary temperature 95.1 F, heart rate 136 beats/minute and arespiratory rate 48 breaths/minute. Based on these findings, which action shouldthe nurse take first?

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Check the infant's arterial blood gases.Notify the pediatrician of the infant's vital signs.Assesstheinfant'sbloodglucoselevel.Encourage the infant to take the breast or sugar water.RationaleThe nurse should first assess the infant's blood glucose level (C), because theinfant is displaying signs of hypothermia (normal newborn axillary temperature is96 to 98 F) and hypoglycemia may occur as glucose is metabolized in an effort tomeet cellular energy demands. The infant's respiratory and heart rates are withinnormal limits, so (A) is not a priority. (B and D) would be implemented afterinformation regarding the blood sugar level has been obtained.A client who is breastfeeding develops engorged breasts on the third postpartumday. Which action should the nurse recommend to relieve breast engorgement?Avoid pumping her breasts.Continuebreastfeedingevery2hours.Skip a feeding to rest the breasts.Decrease fluid intake for at least 24 hours.RationaleBreastfeeding every 2 hours should decrease the engorgement (B) and promotelactation that equals the neonate's demands. Skipping feedings (C) increases thesymptoms of engorgement and may subsequently reduce milk production. Usinga breast pump increases the amount of milk expressed which decreasesengorgement and discomfort, so the client should be encouraged to pump, not(A). Decreasing fluid intake (D) does not alleviate the breast engorgement and isnot recommended.A client delivers her first infant and asks the nurse if her skin changes frompregancy are permanent. Which change should the nurse tell the client willremain after pregnancy?Pruritus.Chloasma.Vascular spiders.Striae gravidarum.RationaleStriae gravidarum (D), or “stretch marks,” occur on the lower abdomen ofpregnant women during the second half of pregnancy fade after delivery but donot disappear entirely because they reflect separation within the underlyingconnective (collagen) tissue of the skin. Pruritis (A) is a temporary skin conditionmost commonly caused by cholestasis. Chloasma (B), or “mask of pregnancy,” isa temporary, blotchy, brownish hyperpigmentation caused by hormonal levels ofpregnancy. Vascular spiders (C), or “angiomas,” are small, pulsating endarterioles, found on the upper body, that occur as a result of increased circulatingestrogen, which usually disappear soon after delivery.The nurse notes a pattern of the fetal heart rate decreasing after each contraction.What action should the nurse implement?Give10litersofoxygenviafacemask.Prepare for an emergency cesarean section.

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