HESI RN
HESI Maternity Test Bank
1. A newborn with a yellow abdomen and chest is being assessed. What should be the nurse's initial action?
- A. Assess bilirubin level.
- B. Administer phototherapy.
- C. Encourage feeding to help reduce bilirubin levels.
- D. Perform a bilirubin test every hour.
Correct answer: A
Rationale: The correct action when assessing a newborn with a yellow abdomen and chest is to initially assess the bilirubin level. This helps determine the severity of jaundice in the newborn. Administering phototherapy (choice B) is a treatment intervention that follows the assessment. Encouraging feeding (choice C) can help with bilirubin excretion but is not the initial assessment. Performing a bilirubin test every hour (choice D) may not be necessary initially and could lead to unnecessary interventions.
2. The client is 24 weeks gestation and reports increased thirst and urination. Which diagnostic test result should the nurse report to the healthcare provider?
- A. Hemoglobin A1C.
- B. Postprandial blood glucose test.
- C. Oral glucose tolerance test.
- D. Fasting blood glucose.
Correct answer: C
Rationale: An abnormal oral glucose tolerance test result is indicative of gestational diabetes. This test is crucial in diagnosing gestational diabetes as it evaluates how well the body processes glucose after a sugary drink. Reporting abnormal results promptly allows for timely intervention and management to ensure the well-being of both the mother and the baby. The other options are not the primary tests used to diagnose gestational diabetes. Hemoglobin A1C is not recommended for diagnosing gestational diabetes as it reflects long-term glucose control. Postprandial blood glucose and fasting blood glucose tests are not as sensitive as the oral glucose tolerance test for diagnosing gestational diabetes.
3. A child with ADHD needs help with homework. What should the nurse encourage the parents to do?
- A. Encourage the parents to help the child with homework.
- B. Do the homework for the child.
- C. Set a regular homework schedule.
- D. Provide a quiet environment for homework.
Correct answer: A
Rationale: Encouraging parents to help the child with homework is the most appropriate course of action. By assisting the child, parents can provide necessary support and guidance without taking over the task entirely. This approach fosters independence and helps the child develop academic skills. Option B, doing the homework for the child, is counterproductive as it does not empower the child to learn and grow independently. Option C, setting a regular homework schedule, is important but does not address the immediate need for assistance. Option D, providing a quiet environment for homework, is helpful but does not directly involve parents in supporting the child's academic progress.
4. A pregnant woman in the first trimester of pregnancy has hemoglobin of 8.6 g/dl and a hematocrit of 25.1%. What food should the nurse encourage this client to include in her diet?
- A. Carrots
- B. Chicken
- C. Yogurt
- D. Cheese
Correct answer: B
Rationale: During pregnancy, it is common for women to experience a drop in hemoglobin levels, leading to anemia. Chicken is a good dietary source of iron, which is essential for increasing hemoglobin levels. Iron from animal sources, such as chicken, is more readily absorbed by the body compared to plant-based sources. Therefore, encouraging the client to include chicken in her diet can help improve her hemoglobin levels and combat anemia.
5. A laboring client’s membranes rupture spontaneously. The nurse notices that the amniotic fluid is greenish-brown. What intervention should the nurse implement first?
- A. Turn the client to her left side
- B. Contact the healthcare provider
- C. Assess the fetal heart rate
- D. Check the cervical dilation
Correct answer: C
Rationale: The correct answer is to assess the fetal heart rate. When amniotic fluid is greenish-brown, it may indicate the presence of meconium, which can be concerning as it may lead to fetal distress. Assessing the fetal heart rate will help determine the well-being of the fetus and guide further actions to ensure the safety of both the mother and the baby.
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