OB HESI EXAM PRACTICE 2024 V1. ACTUAL EXAM QUESTIONS AND ANSWERS. COMPLETE LATEST UPDATE RATED A+.

OB HESI EXAM PRACTICE 2024 V1. ACTUAL EXAM QUESTIONS AND ANSWERS. COMPLETE LATEST UPDATE RATED A+. multiparous client delivered a 7 lb 10 oz infant 5 hours ago. Upon fundal assessment, the nurse determines the uterus is boggy and is displaced above and 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. ANSWER EXAPLANATION: Fundus displacement commonly occurs in the early hours of the postpartum period due to urinary retention, so assisting the client to the bathroom (C) to void should be implement next. (A and B) can be completed after the client's bladder is emptied. (D) should only be implemented if the fundus does not become firm or lochial bleeding continues after the bladder is emptied. A client at 28-weeks gestation experiences blunt abdominal trauma. Which parameter 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. ANSWER EXAPLANATION: Hypoperfusion of the fetus may be present before the onset of clinical signs of maternal compromise or shock in a pregnant woman, so the external fetal monitor tracings should be assessed first to determine signs of fetal hypoxia due to internal bleeding in the mother. (A, B, and D) are not the first findings of internal hemorrhage in the pregnant client. The nurse is assessing a full-term newborn’s breathing pattern. Which findings should the nurse assess further? (Select all that apply.) Select all that apply Some correct answers were not selected Shallow 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. Grunting heard with a stethoscope. ANSWER EXAPLANATION: Breathing with nasal flaring, diaphragmatic breathing with chest retraction, and grunting are signs of respiratory distress in the infant. The nurse is discussing the stages of labor with a group of women in the last month of pregnancy and provides examples of different positional techniques used during the second stage of labor. Which position should the nurse address that provides the best advantage of gravity during delivery? Walking. Squatting. Kneeling. Lithotomy. ANSWER EXAPLANATION: Squatting (B) helps to align the fetus with the pelvic outlet and allows gravity to assist in fetal descent and gives the client an adventitious position for birth. Although walking (A) and kneeling (C) also help to align the fetus with the pelvic outlet and allow for gravity to assist in fetal descent, these do not accomodate birth easily. The predominant position in the United States for physician-attended births is the lithotomy position which requires a woman to be in a reclined position with her legs in stirrups in which gravity has little effect in this position (D). What action should the nurse implement when caring for a newborn receiving phototherapy? Reposition every 6 hours. Place an eyeshield over the eyes. Limit the intake of formula. Apply an oil-based lotion to the skin. ANSWER EXAPLANATION: Phototherapy converts unconjugated bilirubin, which is deposited in the skin, to a water-soluble form that is more easily excreted by the liver. Exposure to the light source can increase the risk for ocular damage, so an eyeshield (B) is placed while the infant is under the light source. To ensure all body surfaces are exposed to the lights, the newborn should be reposition every 2 to 4 hours, not every 6 hours (A). Phototherapy can increase insensible water loss, and to prevent dehydration, fluid intake should be encouraged, not restricted (C). Lotions (D) absorb heat and can potentially cause burns and should not be used on the skin while phototherapy is in progress. During an assessment of a multiparous client who delivered an 8-lb 7-oz infant 4 hours ago, the nurse notes the client's perineal pad is completely saturated within 15 minutes. What action should the nurse implement next? Perform fundal massage. Assess blood pressure. Notify the healthcare provider. Encourage the client to void. ANSWER EXAPLANATION: Perineal pad saturation within 15 minutes during the early post partum period is indicative of bleeding, which is commonly due to uterine atony and can lead to post-partum hemorrhage. Fundal assessment and massage should be performed (A) first to control bleeding. (B, C, and D) are actions implemented after manually stimulating the fundus to contract. Which nonpharmacologic interventions should the nurse implement to provide the most effective response in decreasing procedural pain in a neonate? Tactile stimulation. Commercial warm packs. Skin-to-skin contact with parent. Oral sucrose and nonnutritive sucking. ANSWER EXAPLANATION: Studies of nonpharmacologic interventions for pain in the newborn most frequently indicate that the administration of oral sucrose and nonnutritive sucking (D), such as the provision of a pacifier, are effective in reducing objective indicators of pain after an invasive procedure. Other interventions, such as tactile stimulation (A) during apnea and bradycardic episodes and warm packs (B) for thermoregulation, have not been shown to reduce pain responses. Skin-to-skin contact (C) fosters neurobehavioral development and supporting parent-infant intimacy and attachment, but sucking behaviors provide the most effective pain-comfort responses. Which cardiovascular findings should the nurse assess further in a client who is at 20-weeks gestation? Decrease in pulse rate. Decrease in blood pressure. Increase in heart sounds (S1, S2). Increase in red blood cell production. ANSWER EXAPLANATION: Between 14 and 20 weeks gestation, the pulse increases about 10 to 15 beats/minute, which persists to term, so a decrease (A) should be assessed further. During the second trimester, both systolic and diastolic pressures decrease by about 5 to 10 mm Hg (B), a more audible splitting of S1 and S2 occurs (C), and there is an accelerated production of red blood cells (D). A client comes in to the clinic for her six week postpartum check up and complains that her left breast is eythematous and painful. The client asks, "Can I still breastfeed my baby?" What is the best response for the nurse to provide? Advise to stop breastfeeding until the infection clears. Inform the client to continue breastfeeding. Begin all feedings with the infected breast. Tell the client to pump then discard the milk from the affected breast. ANSWER EXAPLANATION: The client should be encouraged to continue breastfeeding (B) because emptying the breast helps alleviate the pain and prevents abscess formation. (A, C, and D) are inaccurate instructions for a breastfeeding client with mastitis. A client at 39-weeks gestation is admitted to the labor and delivery unit. Her obstetrical history includes 3 live births at 39-weeks, 34-weeks, and 35-weeks gestation. Using the GTPAL system, which designation is the most accurate summary of this client's obstetrical history? 3-1-1-1-3. 4-1-2-0-3. 3-0-3-0-3. 4-3-1-0-2. ANSWER EXAPLANATION: The client with 3 previous gravid experiences and this current pregnancy totals 4 gravid experiences, and 1 term delivery (37-weeks or greater), 2 preterm deliveries (20 to 37 weeks, whether viable or not viable), no spontaneous abortions and 3 living children. (B) best designates this client's obstetrical history. (A, C, and D) are inaccurate for this client's history using the TPAL system. A multigravida client at 35-weeks gestation is diagnosed with pregnancy-induced hypertension (PIH). Which symptom should the nurse instruct the client to report immediately? Backache. Constipation. Blurred vision. Increased urine output. ANSWER EXAPLANATION: Blurred vision, headache, visual changes, and epigastric discomfort are the most common symptoms experienced by a client with PIH and may indicate impending seizures and should be reported. The nurse is assessing a full-term newborn’s breathing pattern. Which findings should the nurse assess further? (Select all that apply.) Select all that apply Some correct answers were not selected Shallow with an irregular rhythm. Chest breathing with nasal flaring. Diaphragmatic with chest retraction. Abdominal with synchronous chest movements. Rate of 58 breaths per minute. Grunting heard with a stethoscope. ANSWER EXAPLANATION: Breathing with nasal flaring, diaphragmatic breathing with chest retraction, and grunting are signs of respiratory distress in the infant. Which action is most important for the nurse to implement for a client at 36-weeks gestation who is admitted with vaginal bleeding? Monitor uterine contractions. Apply disposable pads under the client. Determine fetal heart rate and maternal vital signs. Obtain blood samples for hemoglobin hematocrit levels. ANSWER EXAPLANATION: The priority nursing action is assessment of the fetal heart rate and maternal vital signs (C) to evaluate the impact of blood loss in the mother and fetus. Although monitoring uterine activity (A), applying pads to assess bleeding amount (B), and obtaining samples for hemoglobin and hematocrit levels (D) should be implemented, these are not as important as assessing maternal and fetal well-being. A woman, whose pregnancy is confirmed, asks the nurse what the function of the placenta is in early pregnancy. What information supports the explanation that the nurse should provide? Excretes prolactin and insulin. Produces nutrients for fetal nutrition. Secretes both estrogen and progesterone. Forms a protective, impenetrable barrier. ANSWER EXAPLANATION: One of the early functions of the placenta as an endocrine gland is the production of four hormones, hCG, hPL, estrogen, and progesterone (C), necessary to maintain the pregnancy and support the embryo and fetus. The placenta does not excrete prolactin and insulin (A). The placenta functions as a means of metabolic exchange between the maternal and fetal blood supplies, but it does not produce nutrients (B), and is not impenetrable (D) because many bacteria and viruses can cross the placental membrane. A client who is at 24-weeks gestation presents to the emergency department holding her arm and complaining of pain. The client reports she fell down the stairs. Which observation should alert the nurse to a possible battering situation? The woman and her partner are having a loud and hostile argument. The woman avoids eye contact and hesitates while answering questions. Other parts of her body have injuries that are in different stages of healing. Examination reveals a fracture to the right humerus and multiple bruises. ANSWER EXAPLANATION: A battered woman often has multiple injuries in various stages of healing (C). Hostile arguing, avoiding eye contact and traumatic injuries (A, B, and D)) are not always indications of battering. An infant with hyperbilirubinaemia is receiving phototherapy. What intervention should the nurse implement? Maintain NPO status. Monitor temperature. Apply skin lotion as prescribed. Change T-shirt every 3 hours. ANSWER EXAPLANATION: Minor side effects of phototherapy include loose, green stools, transient rashes, hyperthermia, increased metabolic rate, dehydration, electrolyte disturbances, and priapism. Regular monitoring of the infant's temperature (B) allows evaluation of hyperthermia and dehydration. Extra oral fluids are provided to reduce the risk of dehydration, so NPO status is not necessary (A). Skin lotion is contraindicated (C) to prevent increased tanning or an increase in heat or skin "frying" effect. Clothing reduces the area of exposed skin to the lights, so T-shirts (D) should not be worn during phototherapy. A client at 29-weeks gestation with possible placental insufficiency is being prepared for prenatal testing. Information about which diagnostic study should the nurse provide information to the client? Amniocentesis. Ultrasonography. Chorionic villus sampling. Maternal serum alpha-fetoprotein. ANSWER EXAPLANATION: Gestational age, fetal growth, and the status and position of the placenta are monitored by ultrasound. Which nursing intervention best enhances maternal-infant bonding during the fourth stage of labor? Brighten the lighting so the mother can view the