HESI LPN
Maternity HESI Test Bank
1. A nurse is caring for a newborn who is 6 hours old and has a bedside glucometer reading of 65 mg/dL. The newborn’s mother has type 2 diabetes mellitus. Which of the following actions should the nurse take?
- A. Obtain a blood sample for a serum glucose level
- B. Feed the newborn immediately
- C. Administer 50 mL of dextrose solution IV
- D. Reassess the blood glucose level prior to the next feeding
Correct answer: D
Rationale: A bedside glucometer reading of 65 mg/dL is within the normal range for a newborn. Reassessing the blood glucose level prior to the next feeding ensures ongoing monitoring without unnecessary intervention. Obtaining a blood sample for a serum glucose level (Choice A) is not necessary as the initial reading is normal. Feeding the newborn immediately (Choice B) may not be indicated and could lead to unnecessary interventions. Administering dextrose solution IV (Choice C) is not warranted as the glucose level is within the normal range and does not require immediate correction.
2. Which of the following statements is true about Tay-Sachs disease?
- A. It is most commonly found among children in Jewish families of Eastern European background.
- B. Children who have this disease suffer from excessive production of mucus in the lungs and pancreas.
- C. It is most commonly found among children in Asian American families.
- D. Children who have this disease suffer from muscular dystrophy characterized by a weakening of the muscles.
Correct answer: A
Rationale: The correct answer is A. Tay-Sachs disease is most commonly found among Jewish families of Eastern European descent. It is a fatal genetic disorder that affects the nervous system. Choice B is incorrect because Tay-Sachs disease does not involve excessive mucus production in the lungs and pancreas. Choice C is incorrect as it states that Tay-Sachs disease is most commonly found among Asian American families, which is inaccurate. Choice D is also incorrect because Tay-Sachs disease does not cause muscular dystrophy characterized by weakening of the muscles.
3. _________ are problems that stem from the interaction of heredity and environmental factors.
- A. Multifactorial problems
- B. Cognitive problems
- C. Horizon problems
- D. Coronal problems
Correct answer: A
Rationale: Multifactorial problems are conditions that result from the interplay of genetic and environmental factors. These conditions, such as diabetes or heart disease, are not solely determined by genetics or environment but are influenced by a combination of both factors. Choice B, cognitive problems, refers to difficulties related to thinking, learning, and memory and are not specifically linked to genetic and environmental interactions. Choices C and D, horizon problems and coronal problems, are nonsensical terms and do not relate to the interaction of heredity and environmental factors.
4. Is Duchenne muscular dystrophy a sex-linked abnormality?
- A. TRUE
- B. FALSE
- C. Sometimes
- D. Always
Correct answer: A
Rationale: The correct answer is A: TRUE. Duchenne muscular dystrophy is an X-linked recessive disorder, primarily affecting males. This is due to the inheritance of the mutated gene on the X chromosome. Choices B, C, and D are incorrect because Duchenne muscular dystrophy is specifically classified as a sex-linked disorder affecting males due to the inheritance pattern.
5. A newborn is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?
- A. Apply a thin layer of lotion to the newborn's skin every 8 hours.
- B. Give the newborn 1 oz of glucose water every 4 hours.
- C. Ensure the newborn's eyes are closed beneath the shield.
- D. Dress the newborn in a thin layer of clothing during therapy.
Correct answer: C
Rationale: During phototherapy using a lamp, it is crucial to protect the newborn's eyes from the light to prevent damage. Closing the newborn's eyes beneath the shield is essential for this purpose. Applying lotion to the skin (Choice A) is not recommended as it can intensify the effects of the phototherapy. Giving glucose water (Choice B) is unrelated to the phototherapy process and is not indicated. Dressing the newborn in clothing (Choice D) may hinder the effectiveness of the phototherapy by blocking the light exposure to the skin.
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