HESI LPN
HESI Maternal Newborn
1. In the prenatal record, the nurse should record for the pregnant client who has a 3-year-old child at home, a term birth, a miscarriage at 10 weeks’ gestation, and a set of twins who died within 24 hours:
- A. Gravida 2, para 1.
- B. Gravida 3, para 3.
- C. Gravida 4, para 2.
- D. Gravida 5, para 4.
Correct answer: C
Rationale: The correct answer is C: 'Gravida 4, para 2.' Gravida refers to the total number of pregnancies, including the current one. In this case, the client has been pregnant a total of 4 times, so gravida is 4. Para is the number of pregnancies that have reached viability, which is 2 in this case. The client has had a term birth and a set of twins who died within 24 hours, totaling 2 pregnancies that reached viability. Choices A, B, and D are incorrect because they do not accurately reflect the client's obstetric history based on the information provided.
2. Preconception counseling is crucial for the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?
- A. Frequent episodes of maternal hypoglycemia
- B. Congenital anomalies in the fetus
- C. Hydramnios
- D. Hyperemesis gravidarum
Correct answer: B
Rationale: Preconception counseling is essential as strict metabolic control before conception and in the early weeks of gestation helps reduce the risk of congenital anomalies. Frequent episodes of maternal hypoglycemia usually occur during the first trimester due to hormonal changes, affecting insulin production and use, rather than before conception. Hydramnios is more common in diabetic pregnancies, typically seen in the third trimester, not during early pregnancy. Hyperemesis gravidarum, although it may lead to hypoglycemic events, is related to decreased food intake and glucose transfer to the fetus, exacerbating hypoglycemia rather than being directly associated with poor glycemic control before and during early pregnancy.
3. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?
- A. Temperature 37.9°C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg.
- B. Temperature 37.4°C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg.
- C. Temperature 38°C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg.
- D. Temperature 36.8°C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg.
Correct answer: A
Rationale: An estimated blood loss (EBL) of 1500 ml following a vaginal birth is significant and can lead to hypovolemia. The vital signs provided in option A (Temperature 37.9°C, heart rate 120 bpm, respirations 20 breaths per minute, and blood pressure 90/50 mm Hg) indicate tachycardia and hypotension, which are concerning signs of hypovolemia due to excessive blood loss. Tachycardia is the body's compensatory mechanism to maintain cardiac output in response to decreased blood volume, and hypotension indicates inadequate perfusion. Options B, C, and D do not exhibit the same level of concern for hypovolemia. Option B shows tachypnea, which can be a result of pain or anxiety postpartum. Option C and D have vital signs within normal limits, which are not indicative of the body's response to significant blood loss.
4. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?
- A. Urine protein concentration of 200 mg/24 hr.
- B. Creatinine level of 0.8 mg/dL
- C. Hemoglobin level of 14.8 g/dL
- D. Platelet count of 60,000/mm3
Correct answer: D
Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.
5. Which of the following is a fatal genetic neurologic disorder whose onset is in middle age?
- A. Tay-Sachs disease
- B. Duchenne muscular dystrophy
- C. Hemophilia
- D. Huntington’s disease
Correct answer: D
Rationale: Huntington's disease is a fatal genetic neurologic disorder characterized by progressive nerve cell degeneration in the brain. It typically manifests in middle age with symptoms such as involuntary movements, cognitive decline, and psychiatric disturbances. Tay-Sachs disease (Choice A) is a genetic disorder that primarily affects the nervous system in early childhood, not middle age. Duchenne muscular dystrophy (Choice B) is a genetic disorder that primarily affects muscle function and usually presents in early childhood. Hemophilia (Choice C) is a genetic disorder related to blood clotting, and its onset is not typically in middle age.
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