Maternity HESI 1

1. A 38-week primigravida who works as a secretary and sits at a computer for 8 hours

each day tells the nurse that her feet have begun to swell. Which instruction would be

most effective in preventing pooling of blood in the lower extremities?

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 straighten out the pelvic

veins and increase venous return.

2. A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28-weeks gestation

in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg

subcutaneously to stop her labor contractions. The nurse plans to monitor for which

primary side effect of terbutaline sulfate?

Tachycardia and a feeling of nervousness

Terbutaline sulfate (Brethine), a beta-sympathomimetic drug, stimulates beta-adrenergic

receptors in the uterine muscle to stop contractions. The beta-adrenergic agonist

properties of the drug may cause tachycardia, increased cardiac output, restlessness,

headache, and a feeling of "nervousness".

3. When do the anterior and posterior fontanels close?

anterior fontanel closes at 12 to 18 months and the posterior by the end of the second

month.

4. When assessing a client who is at 12-weeks gestation, the nurse recommends that she

and her husband consider attending childbirth preparation classes. When is the best

time for the couple to attend these classes?

30 weeks gestation

at 30 weeks gestation is closest (of the options) to the time parents would be ready for

such classes. Learning is facilitated by an interested pupil! The couple is most

interested in childbirth toward the end of the pregnancy when they are psychologically

ready for the termination of the pregnancy, and the birth of their child is an immediate

concern.

5. The nurse should encourage the laboring client to begin pushing when...

the cervix is completely dilated.

Pushing begins with the second stage of labor, i.e., when the cervix is completely

dilated at 10 cm (C). If pushing begins before the cervix is completely dilated the cervix

can become edematous and may never completely dilate, necessitating an operative

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delivery. Many primigravida’s begin active labor 100% effaced and then proceed to

dilate.

6. The nurse instructs a laboring client to use accelerated-blow breathing. The client

begins to complain of tingling fingers and dizziness. What action should the nurse take?

Have the client breathe into her cupped hands

Tingling fingers and dizziness are signs of hyperventilation (blowing off too much carbon

dioxide). Hyperventilation is treated by retaining carbon dioxide. This can be facilitated

by breathing into a paper bag or cupped hands.

7. Twenty-four hours after admission to the newborn nursery, a full-term male infant

develops localized edema on the right side of his head. The nurse knows that, in the

newborn, an accumulation of blood between the periosteum and skull which does not

cross the suture line is a newborn variation known as...

a cephalohematoma, caused by forceps trauma and may last up to 8 weeks.

Cephalohematoma, a slight abnormal variation of the newborn, usually arises within the

first 24 hours after delivery. Trauma from delivery causes capillary bleeding between the

periosteum and the skull.

8. When does the head return to its normal shape?

7-10 days

9. What did Nurse theorist Reva Rubin describe?

The initial postpartum period as the "taking-in phase," which is characterized by

maternal reliance on others to satisfy the needs for comfort, rest, nourishment, and

closeness to families and the newborn.

10. A couple, concerned because the woman has not been able to conceive, is referred to a

healthcare provider for a fertility workup and a hysterosalpingography is scheduled.

Which post procedure complaint indicates that the fallopian tubes are patent?

Shoulder pain

If the tubes are patent (open), pain is referred to the shoulder from a sub diaphragmatic

collection of peritoneal dye/gas.

11. Which nursing intervention is most helpful in relieving postpartum uterine contractions or

"afterpains?"

Lying prone with a pillow on the abdomen

Lying prone keeps the fundus contracted and is especially useful with multiparas, who

commonly experience afterpains due to lack of uterine tone.

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12. Which maternal behavior is the nurse most likely to see when a new mother receives

her infant for the first time?

Her arms and hands receive the infant and she then traces the infant's profile with her

fingertips.

Attachment/bonding theory indicates that most mothers will demonstrate behaviors

described in during the first visit with the newborn, which may be at delivery or later.

13. A client at 32-weeks gestation is hospitalized with severe pregnancy-induced

hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms.

Which assessment finding indicates the therapeutic drug level has been achieved?

A decreased in respiratory rate from 24 to 16

Magnesium sulfate, a CNS depressant, helps prevent seizures. A decreased respiratory

rate indicates that the drug is effective. (Respiratory rate below 12 indicates toxic

effects.)

14. Urinary output must be monitored when administering magnesium sulfate and should be

at least 30 ml per hour. (The therapeutic level of magnesium sulfate for a PIH client is

4.8 to 9.6 mg/dl.) What is the therapeutic level of magnesium sulfate?

The therapeutic level of magnesium sulfate for a PIH client is 4.8 to 9.6 mg/dl.

What does it help prevent? helps prevent seizures

What indicates toxic levels? 3

Respiratory rate below 12 indicates toxic effects.

Urine output of less than 100 ml/4 hours

Absent DTRs

15. Twenty minutes after a continuous epidural anesthetic is administered, a laboring

client's blood pressure drops from 120/80 to 90/60. What action should the nurse take?

Place woman in a lateral position

The nurse should immediately turn the woman to a lateral position, place a pillow or

wedge under the right hip to deflect the uterus, increase the rate of the main line IV

infusion, and administer oxygen by face mask at 10-12 L/min. If the blood pressure

remains low, especially if it further decreases, the anesthesiologist/healthcare provider

should be notified immediately.

16. A client at 28-weeks gestation calls the antepartum clinic and states that she is

experiencing a small amount of vaginal bleeding which she describes as bright red. She

further states that she is not experiencing any uterine contractions or abdominal pain.

What instruction should the nurse provide?

Come to the clinic today for an ultrasound

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Third trimester painless bleeding is characteristic of a placenta previa. Bright red

bleeding may be intermittent, occur in gushes, or be continuous. Rarely is the first

incidence life-threatening, nor cause for hypovolemic shock. Diagnosis is confirmed by

transabdominal ultrasound.

17. An off-duty nurse finds a woman in a supermarket parking lot delivering an infant while

her husband is screaming for someone to help his wife. Which intervention has the

highest priority?

Put the newborn to breast

Putting the newborn to breast will help contract the uterus and prevent a postpartum

hemorrhage--this intervention has the highest priority.

18. A pregnant client with mitral stenosis Class III is prescribed complete bedrest. The client

asks the nurse, "Why must I stay in bed all the time?" Which response is best for the

nurse to provide this client?

Complete bedrest decreases oxygen needs and demands on the heart muscle tissue.

To help preserve cardiac reserves, the woman may need to restrict her activities and

complete bedrest is often prescribed.

19. The nurse is teaching care of the newborn to a group of prospective parents and

describes the need for administering antibiotic ointment into the eyes of the newborn.

Which infectious organism will this treatment prevent from harming the infant?

Gonorrhea

Erythromycin ointment is instilled into the lower conjunctiva of each eye within 2 hours

after birth to prevent ophthalmic neonatorum, an infection caused by gonorrhea, and

inclusion conjunctivitis, an infection caused by chlamydia. The infant may be exposed to

these bacteria when passing through the birth canal.

20. The nurse is teaching a woman how to use her basal body temperature (BBT) pattern

as a tool to assist her in conceiving a child. Which temperature pattern indicates the

occurrence of ovulation, and therefore, the best time for intercourse to ensure

conception?

Between the time the temperature falls and rises.

In most women, the BBT drops slightly 24 to 36 hours before ovulation and rises 24 to

72 hours after ovulation, when the corpus luteum of the ruptured ovary produces

progesterone. Therefore, intercourse between the time of the temperature fall and rise

is the best time for conception. The human ovum can be fertilized 16 to 24 hours after

ovulation.

4

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