HESI MATERNITY VERSION 1-3 EXAM RATED A+

HESI MATERNITY VERSION 1-3 EXAM RATED A+

When is an amniotomy indicated? - ANSWER>>(artificial rupture of membranes [AROM]) is used to stimulate labor when the condition of the cervix is favorable

How often should maternal blood pressure be done during an amniotomy? - ANSWER>>Maternal BP should be assessed every 15 to 20 minutes during labor

Why is maternal temperature important to monitor after an amniotomy? - ANSWER>>Maternal temperature is monitored hourly after the membranes are ruptured to detect development of amnionitis.

Is it ok for a breastfeeding mother to drink alcohol? - ANSWER>>No, alcohol is excreted through breast milk.

Laboring client is doing accelerated blow breathing and states that she is feeling tingling in her fingers and dizziness. What should the nurse do? - ANSWER>>Have the pt breathe into her cupped hands. She is hyperventilating and excreting too much carbon dioxide.

When does ovulation occur? - ANSWER>>14 days before first day of menstrual period

What is the goal for labor augmentation (administration of Oxytocin/pitocin) - ANSWER>>produce firm contractions that occur every 2 to 3 minutes, with a duration of 60 to 70 seconds, and without evidence of fetal stress.

An infant born breech is at risk for what complication? - ANSWER>>Brachial palsy-- which results from the stretching of nerve fibers in the neck, shoulder, and arm where the shoulder is being pulled away from the neck during a breech delivery.

What are some observations that the newborn is nursing well to breastfeeding? - ANSWER>>-Swallowing is audible

-Mother reports a pulling sensation on her nipple

-The tip of the infant's nose and chin touch the breast

What position does the Pavlik harness put infants with developmental dysplasia of the hip stay in? - ANSWER>>The Pavlik harness keeps the infant in an abducted position allowing the hips and knees flexed

28 wk gestation pt calls the antepartal clinic about bleeding a small amount of bright red blood with no uterine contractions, but is not bleeding anymore. What may this possibly be? - ANSWER>>Placenta previa

Is bleeding a small amount of bright red blood life-threatening to the fetus? - ANSWER>>It is not at risk for hypovolemia or life-threatening.

What may sudden onset bleeding with present uterine contractions indicate? - ANSWER>>Abruptio placenta

When is child-birth class recommended? - ANSWER>>30 weeks

What should a primigravida who has present leg swelling d/t sitting 8 hrs a day do to minimize the swelling? - ANSWER>>Move around every hour

What is important to do for an amniotomy? - ANSWER>>Monitor FHR before, during, and after procedure. The fluid should also be assessed for color, odor, and consistency.

When should jaundice in a newborn be concerning? - ANSWER>>If jaundice is present less than 24 hours of delivery, it may indicate excess bilirubin

What is the action of terbutaline sulfate (Brethine)? - ANSWER>>Stop labor contractions

Primary side effects of terbutaline sulfate (Brethine)? - ANSWER>>Tachycardia and nervousness along with increased CO, restlessness, and headache

When does the anterior fontanel close? - ANSWER>>12-18 months

When does the posterior fontanel close? - ANSWER>>End of second month

Why is erythromycin indicated 2 hours post-delivery of a newborn? - ANSWER>>Prevent opthalmia neonatorum which is an eye infection caused by gonorrhea and conjunctivitis which is an infection caused by chlamydia

Antepartum pt is chewing ice instead of the food on her breakfast tray. What should the nurse do? - ANSWER>>Call HCP immediately. Practice of pica will displace nutrients. Evaluate the pt for anemia

Is it normal for FHR to increase during contractions and return to baseline? - ANSWER>>Yes it is normal for FHR to increase, but this is indicative to increase the pitocin infusion to stimulate the intensity and frequency of the contractions

What should be done if fetal stress is present during labor? - ANSWER>>-Place a wedge on the pts left side

-Administer 10L oxygen nasal cannula

What is important to tell the HCP during the third trimester of pregnancy? - ANSWER>>Signs of preeclampsia--heartburn not relieved by antacids and chronic headaches behind the eye

Normal signs of the last trimester of pregnancy? - ANSWER>>-Increase in fetal heart rate

-Shoes and ring are right

-Inability to sleep for more than 2 hours

Milia - ANSWER>>White pinpoint spots found on the nose and chin that represent blockage of sebaceous glands

Meconium - ANSWER>>First stool that is tarry black

Is pseudostrabismus normal in a newborn? - ANSWER>>Pseudostrabismus is normal until about the 3rd or 4th month. It does not require surgery

A baby is born with an abnormal headshape. How long should it take for it to possibly return to normal? - ANSWER>>It will take 7-10 days for the head to return to a round shape.

Cephalhematoma - ANSWER>>Localized swelling that occurs from forcep trauma between periosteum and skull

At what time after delivery is a cephalhematoma most likely? - ANSWER>>Within the first 24 hours of delivery

Molding - ANSWER>>Occurs when there is too much pressure on the cranium during vaginal delivery. It is common variation and will last about 5-7 days

Can a subarachoid or subdural hematoma be observed from a physical assessment? - ANSWER>>No, these types of hematomas will require further assessment

Signs of hypoglycemia in a newborn - ANSWER>>-Shaking during moro reflex assessment

-Hypothermia

-Lethargy

What is a key characteristic of an infant whose mother smoked during pregnancy? - ANSWER>>Low birth weight