HESI PN OB EXAM PACK BEST FOR 2022 EXAM REVIEW 2 versions

HESI PN OB EXAM

PACK BEST FOR

2022 EXAM REVIEW

2 versions

1. A nurse is assessing a client who is at 33 weeks of gestation. Which of the following findings

should the nurse report to the provider?

a. Epigastric pain: The nurse should notify the provider of the client's report of epigastric pain

because this is a manifestation of preeclampsia. Other findings the nurse should report include

severe headache, blurred vision, confusion, nausea and vomiting, and decreased urinary output.

b. Leukorrhea: Leukorrhea, or vaginal discharge, is an expected finding throughout pregnancy. Leukorrhea increases

during pregnancy due to hypertrophy of the cervix, which increasesthe amount of mucus secreted from the vagina.

c. Excessive salivation: Ptyalism, or excessive salivation, is an expected finding in pregnancy. Increased levels of estrogen

cause an increase in the production of saliva.

d. Darkening of the skin on the face: Hyperpigmentation on the face, or melasma, is an expected finding during

pregnancy. The anterior pituitary gland increases the production of melanocyte-stimulating hormone, causing an

increase in pigmentation of the skin.

2. A nurse is assessing a newborn following a circumcision 48 hr ago. The nurse should identify

that yellow exudate covering the newborn's glans penis indicates which of the following?

a. Wound infection: Infected circumcision wounds appearswollen with a purulent discharge.

b. Ulceration: Yellow exudate following a circumcision is not a manifestation of an ulceration.

c. Exposure to urine: Yellow exudate is not a manifestation resulting from the wound being exposed to urine.

d. Healing: After 24 hours, yellow exudate usually forms over the glans penis and remains for the

next 2 to 3 days. It sometimes forms a crust, which is expected. The nurse should explain that

the yellow film the guardians will see is granulation tissue as the circumcision heals. The

guardians should not remove this tissue.

3. A nurse is developing a plan of care for a client who is in the latent phase of labor. Which of

the following interventions should the nurse include in the plan to manage the client's pain?

a. Encourage the client to listen to music: During the latent phase of labor, the nurse should

implement nonpharmacologicalstrategiesto encourage relaxation and provide pain relief. There

are a wide variety of cutaneous and sensory measures that are simple to implement during this

stage of labor, such as music, rocking, breathing techniques, walking and application of hot or

cold packs.

b. Instruct the client how to use biofeedback: Biofeedback can be an effective method to reduce the discomfort of labor

by promoting self-awareness and relaxation. However, the client must have received instruction and practiced this

technique prior to labor for it to be effective.

c. Administer fentanyl 100 mcg every hour via intermittent IV bolus…Fentanyl is an opioid agonist analgesic that

enhances a client's ability to rest between contractions. However, opioids can also inhibit uterine contractions and

prolong labor. Therefore, avoid administration of opioid analgesia until a client reaches the active phase of labor or

cervical dilation of at least 4 cm.

d. Request the provider administer a pudendal nerve block….A pudendal nerve block relieves pain in the lower vagina

and perineum during the second or third stage of labor. It provides anesthesia for episiotomy or repair of lacerations

following birth.

4. A nurse is reviewing the laboratory results for a postpartum client who is receiving warfarin

for deep-vein thrombosis. Which of the following laboratory tests should the nurse monitor?

a. WBC count: The nurse should monitor the WBC count for clients who have conditions such as chorioamnionitis.

However, it is not necessary for the nurse to monitor this level for a client who is receiving warfarin therapy.

b. International normalized ratio (INR): The nurse should monitor the INR of a client who is taking

warfarin. Prothrombin time (PT) is also measured to regulate warfarin therapy. However, PT

values are more difficult to interpret. INR is determined by multiplying the PT by a correction

factor based on the specific thromboplastin preparation used for the test, as a way of equalizing

laboratory-to-laboratory variations.

c. Plasminogen levels: Plasminogen isfibrinolytic and is usually elevated during pregnancy. However, it is not necessary

for the nurse to monitor this level for a client who is receiving warfarin therapy.

d. Activated partial thromboplastin time (aPTT): The nurse should review aPTT if client is receiving heparin.

5. A nurse is reviewing the medical record of a client who has preeclampsia prior to

administering labetalol. For which of the following findings should the nurse withhold the

medication?

a. Uric acid 7.5 mg/dL: The nurse should identify that a uric acid level of 7.5 mg/dL is above the expected reference

range of 2.7 to 7.3 mg/dL for a client who is pregnant. Elevated uric acid is a manifestation of preeclampsia and is

caused by decreased renal perfusion. However, an elevated uric acid level is not a contraindication for the

administration of labetalol, an antihypertensive medication.

b. Heart rate 54/min: The nurse should identify that a heart rate of 54/min is below the expected

reference range of 60 to 100/min. During pregnancy, the heart rate increases 10 to 15/min due

to increased blood volume and increased tissue demands for oxygen. Bradycardia is a

contraindication for the administration of labetalol, an antihypertensive medication. Therefore,

the nurse should withhold the medication and notify the provider.

c. FHR 112/min: The nurse should identify that an FHR of 112/min is within the expected reference range of 110 to

160/min. Preeclampsia can cause a decrease in placental perfusion, leading to fetal hypoxia. The nurse should closely

monitor the FHR for manifestations of fetal distress. However, the nurse should not withhold labetalol, an

antihypertensive medication, for this finding.

d. BUN 23 mg/dL: The nurse should identify that a BUN of 23 mg/dL is above the expected reference range of 10 to 20

mg/dL for a client who is pregnant. An elevated BUN is a manifestation of preeclampsia and is caused by decreased

renal perfusion. However, an elevated BUN is not a contraindication for the administration of labetalol, an

antihypertensive medication

6. A nurse is assessing a client who is in labor. Which of the following findings should the nurse

expect?

a. Decrease in WBC count: Physical and emotional stress can lead to an increased WBC count.

b. Decrease in blood glucose level: Maternal metabolism, physical exertion, and delivery of the

placenta can lead to a decreased blood glucose level.

c. Decrease in respiratory rate: Anxiety and increased oxygen consumption from physical exertion during labor can lead

to an increased respiratory rate.

d. Decrease in temperature: Vascular changes during labor can lead to an elevated temperature, flushed cheeks, and

warm skin.

7. A nurse is caring for a newborn immediately following birth who has meconium-stained

amniotic fluid and exhibits good muscle tone and respiratory efforts. Which of the following

actions should the nurse take first?

a. Dry the newborn: The nurse should dry the newborn to reduce evaporative heat loss; however, another action is the

priority.

b. Provide tactile stimulation for the newborn.: Tactile stimulation might be required to elicit crying efforts by the

newborn; however, another action isthe priority. Tactile stimulation prior to suctioning of the mouth and pharynx can

cause meconium to enter the airways of the newborn.

c. Begin suctioning of mouth and nose.: The greatest risk to the newborn is injury from meconium

aspiration syndrome and respiratory distress; therefore, the priority action the nurse should take

is to suction the mouth and nose. The nurse should assess the newborn's condition at birth and

suction the newborn's mouth and nose with a bulb syringe based on the assessment findings. If

the newborn's respiratory status is depressed, endotracheal suctioning must be done as well to

remove any meconium that has entered the newborn's airways.

d. Initiate skin-to-skin contact.: Thermoregulation isimportant for all newborns, especially newborns whose respiratory

status might be compromised; however, another action is the priority.

8. A nurse is assessing a client who is at 8 weeks of gestation and has hyperemesis gravidarum.

Which of the following are findings of this condition? (Select all that apply.)

a. Hypertension is incorrect. Hypotension is a finding associated with hyperemesis gravidarum.

a. Tachycardia is correct. Hyperemesis gravidarum typically occurs during the first trimester and

results in electrolyte imbalance, excessive weight loss, ketonuria, and nutritional deficiencies.

Tachycardia is a finding of severe dehydration.

b. Dry mucous membranes is correct. Hyperemesis gravidarum typically occurs during the first

trimester and results in electrolyte imbalance, excessive weight loss, ketonuria, and nutritional

deficiencies. Dry mucous membranes are a finding of severe dehydration.

c. Poorskin turgor is correct. Hyperemesis gravidarum typically occurs during the first trimester

and results in electrolyte imbalance, excessive weight loss, ketonuria, and nutritional

deficiencies. Poor skin turgor is a finding of severe dehydration.

d. Polyuria is incorrect. Polyuria is not a finding associated with hyperemesis gravidarum.

9. A nurse is caring for a newborn who was delivered by cesarean birth 1 min ago and displays

some flexion of the extremities, is not crying, has irregular respiratory effort, and has a heart

rate of 92/min. The nurse notes grimacing but no crying when rubbing the soles of the

newborn's feet. The newborn's skin color is pink with blue extremities. What is the correct

Apgar score?

5: Apgar scoring is an assessment of five areas of newborn well-being: respiratory effort, heart

rate, muscle tone, reflex irritability, and color. For respiratory effort, 0 means absent, 1 means

slow or irregular, and 2 reflects a good cry. This newborn scores 1 for a weak, intermittent

respiratory effort. For heart rate, 0 means absent, 1 is slow (below 100/min), and 2 means

above 100/min. This newborn scores 1 for a heart rate of 92/min. For muscle tone, 0 is flaccid, 1

indicates some flexion of the extremities, and 2 is active motion. This newborn scores 1 for

having some flexion of the extremities. For reflex irritability, 0 means none, 1 is a grimace, and 2

is a vigorous cry. This newborn scores 1 for grimacing with stimulation. For color, 0 is pale or

blue, 1 reflects a pink body with blue extremities, and 2 means completely pink. This newborn

scores 1 for being pink with blue extremities. Adding the newborn's scores of 1, 1, 1, 1, and 1,

this newborn's Apgar score at 1 min is 5.

10. A nurse is planning to obtain a blood specimen from a newborn via a heel stick. Which of

the following actions should the nurse take?

a. Cool the newborn's heel prior to the procedure.: The nurse should warm the newborn's heel for 5 to 10 min to dilate

the blood vessels before obtaining the blood sample.

b. Puncture the center of the newborn's heel.: The nurse should puncture either side of the outer aspect of the

newborn's heel. Puncturing the center of the heel can lead to complications, such as fibrosis, or bone infection.

c. Cleanse the puncture site with alcohol gauze prior to the procedure.: The nurse should clean the

chosen puncture site with alcohol or a facility-approved skin cleanser prior to the procedure to

minimize the risk of infection.

d. Administer vitamin K 30 min prior to each blood draw: Vitamin K is administered as a single intramuscular dose within

1 hr of birth to decrease the risk of newborn bleeding disorders that might occur during the first week following birth.

11. A nurse is teaching a class to clients who are pregnant. Which of the following topics should

the nurse include in the discussion about cesarean birth? (Select all that apply.)

a. Delay in initiating breastfeeding is incorrect. A client who undergoes a cesarean birth with regional anesthesia can

begin breastfeeding without delay, unless a problem with the newborn requires waiting. Skin-to-skin contact can be

initiated during the cesarean birth if the newborn is stable.

b. Management of postpartum pain is correct. The nurse should discuss with clients that they will

have incisional pain and also pain associated with uterine involution.

c. Routine use of intubation equipment during birth is incorrect. Because most cesarean births are performed after the

client receives regional anesthesia, intubation is not necessary.

d. Advantage of early ambulation post-surgical procedure is correct. Early ambulation following a

cesarean birth facilitates circulation in the lower extremities, preventing stasis, and assists with

relieving gas pains.

e. The need for an indwelling urinary catheter during delivery is correct. The nurse should place

an indwelling urinary catheter prior to the cesarean birth to keep the client's bladder empty and

to avoid interference with the surgical procedure.