HESI LPN
HESI Maternal Newborn
1. A client in the transition phase of labor reports a pain level of 7 on a scale of 0 to 10. Which of the following actions should the nurse take?
- A. Instruct the client to use effleurage.
- B. Apply counterpressure to the client's sacrum.
- C. Assist the client with patterned-paced breathing.
- D. Teach the client the technique of biofeedback.
Correct answer: B
Rationale: During the transition phase of labor, a client may experience intense back pain due to the pressure of the baby descending. Applying counterpressure to the client's sacrum can help alleviate this discomfort. Effleurage is a light stroking massage technique that may not provide adequate relief for intense back pain. Patterned-paced breathing is beneficial for managing contractions but may not directly address back pain. Biofeedback is a technique that helps individuals gain awareness and control of certain physiological functions, but it may not be the most appropriate intervention for acute labor pain.
2. 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.
3. A client has experienced a fetal demise following a vaginal delivery at term. What should the nurse advise the client?
- A. “You can bathe and dress your baby if you’d like to.”
- B. “If you don’t hold the baby, it will make letting go much harder.”
- C. “You should name the baby so he/she can have an identity.”
- D. “I’m sure you will be able to have another baby when you’re ready.”
Correct answer: A
Rationale: After a fetal demise, allowing the parents to bathe and dress their baby can offer them a sense of closure and help them in their grieving process. This act can provide a tangible way for the parents to bond with their baby and create lasting memories. Option B is incorrect because each individual may have different emotional needs and holding the baby may not be appropriate or helpful for everyone. Option C, while well-intentioned, may not be suitable for all parents as naming the baby could be emotionally challenging. Option D is insensitive as it overlooks the grieving process of losing a baby by suggesting a replacement.
4. When children who are reared by adoptive parents are nonetheless more similar to their natural parents in a trait, it can be concluded that:
- A. the genetic characteristics of the children change over time.
- B. heredity is solely responsible for how a child grows.
- C. the environment is solely responsible for the development of those characteristics.
- D. genetics play a role in the development of those characteristics.
Correct answer: D
Rationale: When children exhibit traits that are more similar to their biological parents than their adoptive parents, it indicates a strong genetic influence on those traits. This similarity suggests that genetics play a significant role in the development of the observed characteristics. Choice A is incorrect because genetic characteristics do not change over time in this context. Choice B is incorrect as it implies that heredity is the only factor, disregarding the impact of the environment. Choice C is also incorrect as it suggests that only the environment influences trait development, overlooking the genetic contribution.
5. Which of the following statements about Rh incompatibility is true?
- A. Rh incompatibility occurs most commonly during a woman’s first pregnancy.
- B. Rh incompatibility is an untreatable condition that leaves a woman infertile for the rest of her life.
- C. Rh incompatibility is an abnormality that is transmitted from generation to generation and carried by a sex chromosome.
- D. Rh incompatibility occurs due to antibodies transmitted to a fetus during subsequent deliveries causing brain damage or death.
Correct answer: D
Rationale: Rh incompatibility occurs when the mother's antibodies attack the fetus's red blood cells, leading to serious complications, usually in subsequent pregnancies. Choice A is incorrect because Rh incompatibility often occurs in subsequent pregnancies, not necessarily the first one. Choice B is incorrect as Rh incompatibility does not render a woman infertile but can lead to complications during pregnancies. Choice C is incorrect as Rh incompatibility is not carried by a sex chromosome but involves the Rh factor on red blood cells.
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