HESI LPN
HESI Focus on Maternity Exam
1. Does a blastocyst gain mass only when it receives nourishment from outside?
- A. TRUE
- B. FALSE
- C. Sometimes
- D. Always
Correct answer: A
Rationale: A blastocyst does indeed require external nourishment from the mother's body to continue developing and gaining mass. Without this external nourishment, the blastocyst would not be able to grow and develop properly. Therefore, the statement that a blastocyst gains mass only when it receives nourishment from outside is true. Choices B, C, and D are incorrect because they do not accurately reflect the dependency of a blastocyst on external nourishment for its development and growth.
2. A newborn with a respiratory rate of 40 breaths per minute at one minute after birth is demonstrating cyanosis of the hands and feet. What action should a nurse take?
- A. Assess bowel sounds.
- B. Continue to monitor.
- C. Assist with intubation.
- D. Rub the infant's back.
Correct answer: B
Rationale: Cyanosis of the hands and feet, known as acrocyanosis, is common in newborns shortly after birth and usually resolves on its own. It is not indicative of a need for immediate intervention. Therefore, the appropriate action is to continue monitoring the newborn's condition. Assessing bowel sounds (Choice A) is not relevant to the presenting issue of cyanosis and respiratory rate. Assisting with intubation (Choice C) is an invasive procedure that is not warranted based on the information provided. Rubbing the infant's back (Choice D) is not necessary for acrocyanosis and could potentially disturb the newborn.
3. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?
- A. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
- B. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
- C. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
- D. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.
Correct answer: B
Rationale: Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.
4. A charge nurse is teaching a group of staff nurses about fetal monitoring during labor. Which of the following findings should the charge nurse instruct the staff members to report to the provider?
- A. Contraction durations of 95 to 100 seconds
- B. Contraction frequency of 2 to 3 minutes apart
- C. Absent early deceleration of fetal heart rate
- D. Fetal heart rate is 140/min
Correct answer: A
Rationale: The correct answer is A. Contraction durations of 95 to 100 seconds are prolonged, indicating uterine hyperstimulation, which can lead to fetal distress and requires immediate intervention. Reporting this finding to the provider is crucial to ensure timely management and prevent adverse outcomes. Choice B, contraction frequency of 2 to 3 minutes apart, is within the normal range and does not raise immediate concerns. Choice C, absent early deceleration of fetal heart rate, is a reassuring finding suggesting fetal well-being. Choice D, a fetal heart rate of 140/min, is also normal for a fetus and does not typically require immediate reporting unless it deviates significantly from the baseline or is accompanied by other concerning signs.
5. A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include?
- A. Focusing on controlling body functions
- B. Synchronized breathing is often helpful during hypnosis
- C. Hypnosis can be beneficial if practiced during the prenatal period
- D. Hypnosis is ineffective for controlling pain associated with labor
Correct answer: C
Rationale: Hypnosis can be an effective method of pain control during labor, especially if practiced during the prenatal period. Choice A is not specific to hypnosis and may not be directly related. Choice B is not essential for hypnosis and may not always be required. Choice D is incorrect as hypnosis has been shown to be beneficial for managing labor pain when done correctly, making it an inappropriate option to include in the teaching.
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