HESI LPN
Maternity HESI Test Bank
1. When should the low-risk patient, who is 16 weeks pregnant, be advised to return to the prenatal clinic?
- A. 1 week.
- B. 2 weeks.
- C. 3 weeks.
- D. 4 weeks.
Correct answer: D
Rationale: The correct answer is D: 4 weeks. Low-risk pregnant patients typically have prenatal visits every 4 weeks until 28 weeks of gestation. This frequency allows for adequate monitoring of the pregnancy without being overly burdensome on the patient. Choices A, B, and C are incorrect as they do not align with the standard prenatal care schedule for low-risk pregnancies. Visits that are too frequent may cause unnecessary anxiety for the patient, while visits that are too infrequent may miss important opportunities for monitoring and intervention.
2. The nurse has received a report regarding a client in labor. The woman’s last vaginal examination was recorded as 3 cm, 30%, and –2. What is the nurse’s interpretation of this assessment?
- A. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm above the ischial spines.
- B. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines.
- C. Cervix is effaced 3 cm and dilated 30%; the presenting part is 2 cm below the ischial spines.
- D. Cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm below the ischial spines.
Correct answer: B
Rationale: The correct interpretation of the assessment provided is that the cervix is dilated 3 cm and effaced 30%; the presenting part is 2 cm above the ischial spines. In the given assessment, the measurements are ordered as dilation, effacement, and station. Choice A is incorrect as it wrongly places the presenting part below the ischial spines. Choice C is incorrect because it places the presenting part below the ischial spines. Choice D is also incorrect as it incorrectly states that the presenting part is below the ischial spines, even though it correctly mentions the dilation and effacement of the cervix.
3. A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light and asks for her nurse right away, stating 'I’m bleeding a lot.' What is the most likely cause of postpartum hemorrhage in this client?
- A. Retained placental fragments.
- B. Unrepaired vaginal lacerations.
- C. Uterine atony.
- D. Puerperal infection.
Correct answer: C
Rationale: Uterine atony is the most likely cause of bleeding 4 hours after delivery, especially after delivering a macrosomic infant and augmenting labor with oxytocin. Uterine atony is characterized by the inability of the uterine muscles to contract effectively after childbirth, leading to excessive bleeding. The other options, such as retained placental fragments (A), unrepaired vaginal lacerations (B), and puerperal infection (D), are less likely causes of postpartum hemorrhage in this scenario. Retained placental fragments can cause bleeding, but this typically presents earlier than 4 hours postpartum. Unrepaired vaginal lacerations would likely be evident sooner and not typically result in significant bleeding. Puerperal infection is not a common cause of immediate postpartum hemorrhage unless there are other signs of infection present.
4. What additional assessment is required for the postoperative care of a pregnant woman who undergoes abdominal surgery for appendicitis?
- A. Intake and output (I&O) and intravenous (IV) site.
- B. Signs and symptoms of infection.
- C. Vital signs and incision.
- D. Fetal heart rate (FHR) and uterine activity.
Correct answer: D
Rationale: The correct additional assessment for postoperative care of a pregnant woman requiring abdominal surgery for appendicitis is monitoring the fetal heart rate (FHR) and uterine activity. This is crucial due to the presence of the fetus. Continuous fetal and uterine monitoring should be prioritized to ensure the well-being of both the mother and the baby. While assessing I&O levels and the IV site are common postoperative care procedures, they are not specific to the unique needs of a pregnant woman. Evaluating for signs and symptoms of infection is important for any postoperative patient but is not the additional assessment required specifically for a pregnant woman in this scenario. Routine vital signs and incision evaluation are standard components of postoperative care but do not address the specific needs related to the fetus and the uterus in this case.
5. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?
- A. Estriol is not found in maternal saliva.
- B. Irregular, mild uterine contractions occur every 12 to 15 minutes.
- C. Fetal fibronectin is present in vaginal secretions.
- D. The cervix is effacing and dilated to 2 cm.
Correct answer: D
Rationale: The correct answer is D. Cervical changes such as effacement and dilation to 2 cm are strong indicators of imminent preterm labor. These changes, combined with regular contractions, can signify labor at any gestation. Estriol can be detected in maternal plasma as early as 9 weeks of gestation. Levels of salivary estriol have been linked to preterm birth. Irregular, mild contractions occurring every 12 to 15 minutes without cervical change are generally not concerning. While the presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation may predict preterm labor, its predictive value is limited (20%-40%). Therefore, cervical changes provide more reliable information regarding the risk of preterm labor.
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