2020 HESI OB/MATERNITY V 1 the woman does not receive the vaccine.
1. A 3-day postpartum client, who is not immune to
rubella, is to receive the vaccine at discharge. Which of the
following must the nurse include in her discharge teaching
regarding the vaccine?
1. The woman should not become pregnant for at least 4
weeks.
2. The woman should pump and dump her breast milk
for 1 week.
3. The mother must wear a surgical mask when she cares
for the baby.
4. Passive antibodies transported across the placenta will
protect the baby.
2. A 3-day-postpartum client questions why she is to
receive the rubella vaccine before leaving the hospital.
Which of the following rationales should guide the nurse’s
response?
1. The client’s obstetric status is optimal for receiving the
vaccine.
2. The client’s immune system is highly responsive during
the postpartum period.
3. The client’s baby will be high risk for acquiring rubella if
,2020 HESIOBMATERNITY V1.
4. The client’s insurance company will pay for the shot if When asked when she last fed the baby her reply is, “I fed
it is given during the immediate postpartum period. the baby last evening. I let the nurses feed him in the
nursery last night. I needed to rest.” Which of the
3. A patient, G2P1102, who delivered her baby 8 hours
following actions should the nurse take at this time?
ago, now has a temperature of 100.2ºF. Which of the
following is the appropriate nursing intervention at
this time?
1. Notify the doctor to get an order for acetaminophen.
2. Request an infectious disease consult from the doctor.
3. Provide the woman with cool compresses.
4. Encourage intake of water and other
fluids.
4. To prevent infection, the nurse teaches the
postpartum client to perform which of the following
tasks?
1. Apply antibiotic ointment to the perineum
daily. 2. Change the peripad at each voiding.
3. Void at least every two hours.
4. Spray the perineum with a povidone-iodine
solution after toileting.
5. A 3-day-postpartum breastfeeding woman is being
assessed. Her breasts are firm and warm to the touch.
,2020 HESIOBMATERNITY V1.
1. Encourage the woman exclusively to breastfeed her diet while breastfeeding.”
baby.
2. Have the woman massage her breasts hourly.
3. Obtain an order to culture her expressed breast milk.
4. Take the temperature and pulse rate of the woman.
6. A breastfeeding woman has been counseled on how to
prevent engorgement.
Which of the following actions by the mother shows that
the teaching was
effective?
1. She pumps her breasts after each feeding.
2. She feeds her baby every 2 to 3 hours.
3. She feeds her baby 10 minutes on each side.
4. She supplements each feeding with formula.
7. A 2-day-postpartum breastfeeding woman states, “I am
sick of being fat. When can
I go on a diet?” Which of the following responses is
appropriate?
1. “It is fine for you to start dieting right now as long as
you drink plenty of milk.”
2. “Your breast milk will be low in vitamins if you start to
, 2020 HESIOBMATERNITY V1.
3. “You must eat at least 3000 calories per day in order 1. Increase her fluid intake for a few days.
to produce enough milk for
your baby.”
4. “Many mothers lose weight when they
breastfeed because the baby consumes
about 600 calories a day.”
8. A G2P2002, who is postpartum 6 hours from
a spontaneous vaginal delivery, is assessed.
The nurse notes that the fundus is firm at the
umbilicus, there is heavy
lochia, and perineal sutures are intact. Which of
the following actions should the
nurse take at this time?
1. Do nothing. This is a normal finding.
2. Massage the woman’s fundus.
3. Take the woman to the bathroom to void.
4. Notify the woman’s primary health care provider.
9. A client informs the nurse that she intends to
bottlefeed her baby. Which of the
following actions should the nurse encourage the client
to perform?
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