Maternity HESI Exam Preparation, Exams of Nursing

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Maternity HESI ACCURATE TESTED

VERSIONS OF THE EXAM FROM 2023TO

2024 | ACCURATE AND VERIFIED ANSWERS

| NEXT GEN FORMAT | GUARANTEED PASS

The nurse is assessing a breastfed newborn 1 hour after birth. The nurse identified that the glucose levels are less than 25 mg/dL and immediately reported it to the primary health care provider (PHP). What medication administration does the nurse expect the PHP to advise? Cow's milk orally Infant formula orally Intravenous (I.V.) saline infusion Intravenous (I.V.) dextrose infusion

• ANSWERS-Intravenous (I.V.) dextrose infusion The nurse is assessing an infant with a body weight of 2500 g. Two days after delivery the blood report of the infant's mother confirms the presence of hepatitis B. What medication does the primary health care provider instruct the nurse to administer to the infant? Intravenous (I.V.) hepatitis B vaccine Intramuscular (IM) hepatitis B vaccine

Intravenous (I.V.) hepatitis B immune globulin (HBIG) Intramuscular (IM) hepatitis B immune globulin (HBIG)

• ANSWERS-Intramuscular (IM) hepatitis B immune globulin (HBIG) A dose of IM HBIG should be given to the infant whose mother's hepatitis B surface antigen's (HBsAg) status is determined to be positive. The vaccine is also given to infants who weigh 2000 g or more before 1 week of age. The hepatitis B vaccine and HBIG are not given through the IV route in infants because of their adverse effects. The IM hepatitis B vaccine is given to infants born to hepatitis B surface antigen (HBsAg)-negative mothers before being discharged from the hospital. p. 614 The nurse is caring for a postpartum patient who has expelled the placenta spontaneously. The patient is bleeding excessively and has a boggy uterus. What are the most effective nursing interventions in this situation? Administer I.V. nitroglycerin (Nitro-Bid). Administer oxygen inhalation anesthesia. Remove the placental fragments manually. Remove intrauterine contents using a vacuum suction. Perform ultrasonography to detect placental fragments.
• ANSWERS-Remove the placental fragments manually. Remove intrauterine contents using a vacuum suction.

Perform ultrasonography to detect placental fragments. After spontaneous expulsion of the placenta, fragments of placenta may still remain in the uterus. These prevent the uterus from contracting and cause excessive bleeding. Ultrasonography must be performed to detect placental fragments. Manual removal of the placental fragments may be attempted. If the placental fragments cannot be removed by the manual method, they can be removed using a vacuum suction or a curette, in which the placental fragments are removed completely. I.V. nitroglycerin (Nitro-Bid) is administered to the patient to promote uterine relaxation if the placenta is retained. Administration of oxygen inhalation anesthesia is used to expel the placenta when it is retained. This helps in the expulsion of intrauterine contents as well as placental separation. p. 531 The nurse finds that despite gentle traction to the umbilical cord and uterine massage, a patient's placenta has not expelled 30 minutes after childbirth. The primary health care provider instructs the nurse to administer I.V. nitroglycerin (Nitrostat) to the patient. What could be the reason for this instruction? To prevent pelvic hematoma To increase the effects of regional anesthesia To promote uterine relaxation To prevent postpartum hemorrhage

• ANSWERS-To promote uterine relaxation The placenta is usually expelled within 30 minutes after birth. A retained placenta is a condition in which the placenta is not expelled within 30 minutes after birth despite using manual measures, such as gentle traction on the umbilical cord and uterine massage. In this condition I.V. nitroglycerin (Nitrostat) is administered to the patient to promote uterine relaxation.

Nitroglycerin does not affect blood coagulation; therefore it does not prevent pelvic hematoma. Nitroglycerin is not an anesthetic agent; therefore it does not provide regional anesthesia. Nitroglycerin does not cause uterine contractions (UCs), so it does not prevent postpartum hemorrhage. p. 531 Why is the blood volume of premature infants more when compared to term infants? Term-born neonates have fewer platelets. Premature neonates have greater plasma volume. Term-born neonates have decreased clotting factors. Premature neonates have more red blood cells (RBCs).

• ANSWERS-Premature neonates have greater plasma volume. Premature infants have a greater amount of plasma volume. More plasma volume results in higher blood volume compared with term infants. Healthy term-born neonates have an adequate number of RBCs and platelets. Premature infants lack RBCs and therefore lack immunity. Term infants have normal levels of clotting factors. While assessing a newborn, the nurse finds that the infant has partial pressure of oxygen (Po 2) of 50 mm Hg. What physiologic event does the nurse associate with this finding? The ductus arteriosus is closed. The levels of estrogen are increased.

The umbilical veins are constricted. The umbilical arteries are constricted.

• ANSWERS-The ductus arteriosus is closed. Before birth, the aorta and pulmonary arteries are connected by the ductus arteriosus. At birth, the fetal Po 2 is around 20 to 30 mm Hg. In response to an increase in the Po 2 after birth (to around 50 mm Hg), the ductus arteriosus is closed. Umbilical veins and umbilical arteries constrict within 2 minutes of birth. The oxygen saturation is not related to estrogen level. p. 558 With regard to umbilical cord care, nurses should be aware that: the stump can easily become infected. a nurse noting bleeding from the vessels of the cord should immediately call for assistance. the cord clamp is removed at cord separation. the average cord separation time is 5 to 7 days.
• ANSWERS-the stump can easily become infected. The cord stump is an excellent medium for bacterial growth. The nurse should first check the clamp (or tie) and apply a second one. If the bleeding does not stop, then the nurse calls for assistance. The cord clamp is removed after 24 hours when it is dry. The average cord separation time is 10 to 14 days. The nurse is counseling the parents of an infant who has physiologic jaundice after birth. At the time of discharge the mother asks, "What care should I take to prevent recurrence of jaundice in my baby?" How will the nurse respond to the mother's question?

"Breastfeed your baby 10 times a day." "Maintain skin-to-skin contact with the baby." "Feed your baby with cow's milk for 1 week." "Use a bulb syringe when the baby is in an alert state."

• ANSWERS-"Breastfeed your baby 10 times a day." Breastfeeding is one of the best strategies to avoid hyperbilirubinemia, which, in turn, prevents jaundice in the baby by promoting the excretion of bilirubin through stools. Therefore giving the baby breast milk 10 times a day is recommended. Skin-to-skin contact helps promote thermoregulation in a child but does not affect the bilirubin levels. Cow's milk is not suggested in a newborn because it has nutrition imbalances. A bulb syringe is used to clear obstructions in the baby's airway; it is not used to reduce bilirubin levels. The pregnant patient reports severe pain in the midsection of the uterus. Following the assessment, the nurse finds that the patient has frequent uterine contractions (UCs) with cervix dilation up to 2 cm. Which nursing interventions does the nurse perform? Provides hydrotherapy to the patient Administers an analgesic to the patient Administers oxytocin (Pitocin) to the patient Encourages the patient to take a warm shower

Administers zolpidem (Ambien) to the patient

• ANSWERS-Administers an analgesic to the patient Encourages the patient to take a warm shower Administers zolpidem (Ambien) to the patient UCs with cervical dilation up to 2 cm (less than 4 cm) would indicate that the patient is experiencing hypertonic UCs. In such a situation, analgesics should be administered to the patient to reduce the pain caused by the frequent contractions. A warm water bath can be soothing and comfortable for the patient, because it reduces the discomfort caused by the UCs. In the absence of pain, zolpidem (Ambien) can be administered for promotion of sleep and rest. Oxytocin (Pitocin) causes the uterine muscles to contract, which results in heavy contractions and pain aggravation. Hydrotherapy can be used to promote UCs in the active stage of labor. A lactating patient who gave birth to twins 1 month earlier approaches the primary health care provider (PHP) for a general checkup. What suggestion does the nurse give to the patient about the recommended calorie intake? Less than 1800 kcal/day Less than 2200 kcal/day More than 2700 kcal/day Should be 1800 to 2200 kcal/day
• ANSWERS-More than 2700 kcal/day The recommended caloric intake for a lactating mother who breastfeeds more than one infant is more than 2700 kcal/day. If a lactating mother of twins takes less than 2200 kcal/day, she

may not produce enough milk. An intake of 1800 to 2200 kcal/day is recommended for nonlactating mothers. p. 502 A pregnant patient was given a tocolytic drug to prevent preterm delivery. After observing that the patient has a history of migraine headaches, the primary health care provider (PHP) instructs the nurse to stop administering the drug. Which tocolytic drug was the patient most likely taking? Nitrous oxide Magnesium sulfate Terbutaline (Brethine) Prednisolone (Deltasone)

• ANSWERS-Terbutaline (Brethine) Beta-2 adrenergic agonists are contraindicated in patients with migraine headaches. Terbutaline (Brethine) is a toxolytic agent and a beta-2 adrenergic agonist. Therefore the patient was prescribed terbutaline (Brethine). Nitrous oxide is an anesthetic that is contraindicated in patients with asthma but not migraine headaches. Magnesium sulfate is also used as a toxolytic and is contraindicated in patients with cardiac disorders but not migraine headaches. Prednisolone (Deltasone) is a corticosteroid, which is not contraindicated in the patients with migraine headaches. p. 447 The nurse is caring for a pregnant patient who is receiving terbutaline (Brethine) treatment. The primary health care provider (PHP) adds nifedipine (Adalat) to the patient's prescription. How does the nurse administer nifedipine (Adalat) to the patient?

Infuse nifedipine (Adalat) along with terbutaline (Brethine). Infuse nifedipine (Adalat) only after terbutaline (Brethine) is stopped. Provide a glass full of orange juice before administering nifedipine (Adalat). Provide the patient with calcium supplements before administering nifedipine (Adalat). - ANSWERS-Nifedipine (Adalat) is a calcium channel blocker that is used to relax the uterine muscles during pregnancy. Therefore the nurse should avoid administering nifedipine (Adalat) along with terbutaline (Brethine), because it causes adverse effects and may alter the heart rate and blood pressure of the patient. Infusing nifedipine (Adalat) along with terbutaline (Brethine) may impair cardiovascular functioning in the patient. Therefore the nurse should avoid infusing the drugs simultaneously. Orange juice is administered to relax the patient during labor. However, it is not necessary to administer it with nifedipine (Adalat). Nifedipine (Adalat) is administered to reduce the calcium activity; no additional calcium supplementation is required. p. 448 A woman had severe blood loss during the early puerperium. What could be the reason for it? Acute atherosis Elimination of extravascular fluid Loss of uteroplacental circulation Loss of placental endocrine function

• ANSWERS-Loss of placental endocrine function The removal of the placenta causes loss of placental endocrine function. In addition, simultaneous initiation of pulmonary gas exchange in the baby removes the stimulus for

vasodilation in the mother, thereby increasing the blood loss. Acute atherosis is a maternal vascular lesion and is unrelated to blood loss during the postpartum period. Mobilization of the extravascular water stored during pregnancy reduces edema; it does not play a role in postpartum blood loss. Loss of uteroplacental circulation reduces the size of the maternal vascular bed and thereby improves blood circulation. However, this change is not responsible for postpartum blood loss. p. 487 What is the function of Terbutaline?

• ANSWERS-Relaxes uterus The nurse is caring for a pregnant patient who has been prescribed terbutaline (Brethine) to relax the uterus. Following the assessment, the nurse informs the primary health care provider (PHP) that it is not safe to administer terbutaline (Brethine) to the patient. Which patient condition leads the nurse to such a conclusion? Blood pressure of 80/60 mm Hg Short episode of hyperglycemia Irregular episodes of dysrhythmias Heart rate of less than 120 beats/min - ANSWERS-Blood pressure of 80/60 mm Hg Terbutaline (Brethine) relaxes the smooth muscles and inhibits uterine activity (UA). However, the drug can adversely affect the cardiovascular system. Presence of a blood pressure lower than 90/60 mm Hg indicates an adverse effect on the cardiovascular system, and the nurse should stop the treatment to prevent further damage. Short and irregular episodes of hyperglycemia and dysrhythmias are mild and tolerable adverse effects of terbutaline (Brethine), so those conditions would not warrant the discontinuation of the medication. If the patient develops tachycardia greater than 130 beats/min, then the treatment should be stopped.

p. 448 The nurse is caring for a postpartum patient and finds that the patient has internal hemorrhoids. Which clinical manifestations would be consistent with the nurse's findings? Abdominal tenderness White uterine discharge Yellow uterine discharge Bleeding upon defecation Itching sensation in the anus - ANSWERS-Bleeding upon defecation Itching sensation in the anus Internal hemorrhoids can evert while the woman is pushing the baby during childbirth. The patient has internal hemorrhoids due to pregnancy. During pregnancy, pressure from the fetus on the abdomen, as well as hormonal changes, cause hemorrhoids to enlarge. Delivery also leads to increased intraabdominal pressures, which result in internal hemorrhoids. An itching sensation and bleeding upon defecation are the symptoms of internal hemorrhoids. Hemorrhoids usually decrease in size within 6 weeks of childbirth. Abdominal tenderness is a sign of endometritis. White or yellow uterine discharge is a normal finding after delivery. p. The nurse tells the primary health care provider (PHP) that there is 15 mL of fetal blood in maternal circulation, as detected by Kleihauer-Betke test, in an Rh-negative patient. What does the nurse expect the PHP to prescribe to this patient?

300 mcg of intramuscular Rh immune globulin 400 mcg of intramuscular Rh immune globulin 100 mcg of intramuscular Rh immune globulin 200 mcg of intramuscular Rh immune globulin - ANSWERS-300 mcg of intramuscular Rh immune globulin If 15 mL of fetal blood is detected in the maternal circulation of an Rh-negative woman, as indicated by Kleihauer-Betke test, then 300 mcg (1 vial) of Rh immune globulin is usually sufficient to prevent maternal sensitization. A dose of 400 mcg of intramuscular Rh immune globulin may result in an overdosage. A dose of 100 mcg or 200 mcg of intramuscular Rh immune globulin is not sufficient to prevent maternal sensitization. p. 503 A worried postpartum patient reports to the nurse, "It's been 3 weeks after my delivery, and I am still showing." Which is the best response of the nurse? "Reduce the fat content in your diet; it will help you." "Start a vigorous exercise routine, and you will be fine." "Breastfeeding the child will reduce the protruding abdomen." "Three more weeks and you will most likely be back to an almost prepregnant state." - ANSWERS-"Three more weeks and you will most likely be back to an almost prepregnant state." After childbirth, the abdominal wall is relaxed, so the abdomen protrudes similarly to the pregnancy state. This condition usually takes 6 weeks to return to a prepregnant state.

Reducing fat content in the diet may help reduce weight. However, in postpartum patients, the protruding abdomen results from increased elasticity in the uterus and cannot be reduced by reducing fat in the diet. Vigorous exercise should not be prescribed immediately after delivery, because the patient would still be in a fragile state. Breastfeeding would help utilize the fat deposited during the pregnancy, but it does not reduce a protruding abdomen. p. 485 The nurse is assessing a 3-day-old infant with ecchymosis and finds that the condition has not yet healed. The nurse informs the primary health care provider (PHP) of this finding. Which laboratory report would the nurse expect the PHP to order? Platelet count Bilirubin levels Abdominal scan Creatinine levels - ANSWERS-Platelet count Ecchymosis is observed in a newborn as a result of injury caused during delivery. This condition usually heals within 2 days of childbirth. If the condition persists for more than 2 days, the PHP will order to test the platelet count to rule out thrombocytopenic purpura. Thrombocytopenic purpura may be the underlying cause for persistent ecchymosis. Bilirubin levels are usually checked when there is a discoloration of the skin but not for ecchymosis. Abdominal scan and serum creatinine levels are not helpful in determining thrombocytopenic purpura. p. 605 A patient diagnosed with placenta accreta has uncontrolled bleeding, despite medications. What is the best choice for treatment in this situation? Massage the uterus.

Perform a hysterectomy. Replace blood components as needed. Apply traction on the umbilical cord. - ANSWERS-Perform a hysterectomy. Placenta accreta is an obstetric complication in which the placenta adheres to and penetrates the myometrium. The patient with placenta accreta is at risk of hemorrhage during childbirth. If bleeding is not stopped after the administration of medication to the patient, a hysterectomy must be performed to prevent further complications. Replacement of blood components is not useful because the patient has uncontrolled bleeding. Massaging the uterus and applying traction to the umbilical cord is helpful to expel the placenta but is not useful when the placenta is adhered to the uterus. With regard to the use of tocolytic therapy to suppress uterine activity, nurses should be aware that: the drugs can be given efficaciously up to the designated beginning of term at 37 weeks. there are no important maternal (as opposed to fetal) contraindications. its most important function is to afford the opportunity to administer antenatal glucocorticoids. if the woman develops pulmonary edema while on tocolytics, IV fluids should be given. - ANSWERS-its most important function is to afford the opportunity to administer antenatal glucocorticoids. There are important maternal contraindications to tocolytic therapy. After the pregnancy has reached 34 weeks, the risks of tocolytic therapy outweigh the benefits. Buying time for

antenatal glucocorticoids to accelerate fetal lung development might be the best reason to use tocolytics. Tocolytic-induced edema can be caused by IV fluids. Upon assessment of a pregnant patient, the nurse concludes that the patient is less likely to have a preterm delivery. Which patient clinical finding led the nurse to conclude this? Previous cesarean birth Preexisting diabetes mellitus Cervical length of more than 30 mm Symptoms of chronic hypertension - ANSWERS-Cervical length of more than 30 mm The cervical length is a good predictor of preterm birth. For childbirth, the cervix needs to prepare itself in terms of effacement and dilation. Patients having cervical length of more than 30 mm would not have preterm labor, even if they have symptoms of preterm labor. A previous cesarean birth may not rule out the risk of preterm delivery. Chronic hypertension and preexisting diabetes mellitus may not increase the risk of preterm labor. A pregnant patient is administered misoprostol (Cytotec) to induce labor. After 8 hours of drug administration, the patient develops diarrhea and vomiting. What does the nurse do to alleviate the symptoms? Administer terbutaline (Brethine). Administer oxytocin (Pitocin) infusion. Give a magnesium containing antacid.

Increase the time between doses. - ANSWERS-Administer terbutaline (Brethine). The patient is taking misoprostol (Cytotec) medication for labor induction. Vomiting and diarrhea are the adverse effects of the drug. These effects can be reversed by the administration of terbutaline (Brethine) by the subcutaneous route. To prevent the adverse effects, dosing intervals must be increased before the administration. However, increasing the dosing intervals will not be helpful in alleviating these symptoms. Oxytocin (Pitocin) can be given 4 hours after administering the last dose of misoprostol (Cytotec). This is usually given if the labor has not occurred, and it does not prevent the adverse effects of misoprostol (Cytotec). Magnesium containing antacids should not be given to the patients who are taking misoprostol (Cytotec) medication because they interact with each other. p. 462 The nurse is teaching a group of pregnant patients about preterm labor and the actions to take if the signs and symptoms of preterm labor develop. Which patient statement indicates the need for further teaching? "I will empty my bladder immediately." "I will drink 3 to 4 glasses of water or juice." "I will lie in the supine position for 1 hour." "I will go to the hospital if symptoms continue." - ANSWERS-"I will lie in the supine position for 1 hour." If there are signs and symptoms of preterm labor, the patient should lie down on her side for 1 hour, because it helps improve placental and fetal circulation. The patient should empty her bladder immediately, because a full bladder may sometimes irritate the uterus. Dehydration may also irritate the uterus. Therefore the patient should drink 3 to 4 glasses of water or juices. The patient should go to the hospital if the symptoms of preterm labor do not subside. p. 445

A patient has been administered zolpidem (Ambien) as prescribed. What is the patient's clinical condition for prescribing this medication to the patient? Prolonged pregnancy Viral infection in the eye Fibrin accumulation in the placenta Hypertonic uterine contractions (UCs) - ANSWERS-Hypertonic uterine contractions (UCs) Zolpidem (Ambien) is given during labor to provide rest and sleep to the patient who has increased or hypertonic UCs. Patients at risk for prolonged pregnancy are provided with oxytocin (Pitocin) to induce labor. Viral infections are usually treated with antivirals in worst cases but not with zolpidem (Ambien). Fibrin accumulation is caused when pregnancy is prolonged or postponed for more than 40 weeks in a patient. p. 455 The nurse is instructed to administer 12 mg of betamethasone (Celestone) to a pregnant patient at 30 weeks' gestation. Which nursing intervention should be performed for the safe administration of the drug? Give the medication by oral route. Assess platelet levels after drug administration. Administer increased doses of insulin with the drug.

Follow a strict time interval of 24 hours between two doses. - ANSWERS-Follow a strict time interval of 24 hours between two doses. Betamethasone (Celestone) is an antenatal glucocorticoid that is given intramuscularly (IM) to pregnant women between 24 and 34 weeks' gestation. It is administered to prevent morbidity and mortality associated with preterm labor due to respiratory distress syndrome. Therefore the nurse should administer the drug in two doses with a time interval of 24 hours because optimal fetal benefits start 24 hours after the first injection. The drug cannot be administered orally because it may impair the absorption of the drug; therefore the drug must be given only through the IM injection route. Increased doses of insulin are administered only if the patient has a history of well-controlled blood sugar levels. The drug causes increased blood glucose levels and increased white blood cells (WBCs) but not blood platelet levels. Therefore it is not useful to assess the blood platelet levels in the patient after the drug is administered. p. 450 The nurse administers the prescribed nifedipine (Adalat) to a pregnant patient during labor to reduce uterine contractions (UCs). Which nursing action is the most appropriate after the drug administration? Monitoring the: Heart rate of the fetus Blood pressure of the patient Respiration rate of the patient Blood sugar levels in the patient - ANSWERS-Blood pressure of the patient The nurse should monitor the blood pressure of the patient after administering nifedipine (Adalat). It is a calcium channel blocker that compresses the smooth muscle contractions, resulting in hypotension. Nifedipine (Adalat) does not alter fetal heart rate or respiration rate and blood sugar levels of the patient. Heart rate of the fetus is monitored when other classes of tocolytics are administered. Respiration rate is monitored when oxytocin (Pitocin) is

administered to the patient. Blood sugar levels are monitored in patients with diabetes who are receiving glucocorticoid therapy. p. 450 The nurse observes that a pregnant patient has a high temperature and a foul smell of amniotic fluid during labor. Which possible complications would the nurse find in the patient and in the neonate after the delivery? The neonate may have pneumonia. The patient may have a pelvic abscess. The patient may have impaired lactation. The patient may have supine hypotension. The neonate may have bacteremia and sepsis. - ANSWERS-The neonate may have pneumonia. The patient may have a pelvic abscess. The neonate may have bacteremia and sepsis. High maternal fever and a foul odor of amniotic fluid are indicative of chorioamnionitis, which is a bacterial infection of the amniotic cavity. The patient with chorioamnionitis is prone to have a cesarean birth. Therefore the nurse should monitor the possible risks of cesarean birth, like pelvic abscess, neonatal pneumonia, neonatal bacteremia, and sepsis. Impaired lactation and supine hypotension are not complications associated with chorioamnionitis. Impaired lactation may be caused due to a reduction in prolactin levels. Lying in the supine position causes supine hypotension. p. 452

While examining the postpartum patient, the nurse finds that her fundus is located halfway between the umbilicus and the symphysis pubis. When would the nurse suspect was about the time of the patient's delivery? 6 days ago 12 hours ago 24 hours ago 6 weeks ago - ANSWERS-6 days ago The fundus descends gradually from the time of childbirth and returns to its normal nonpregnant state. By the sixth day after childbirth, it can be located halfway between the umbilicus and the symphysis pubis. The fundus rises to approximately 1 cm above the umbilicus within 12 hours of childbirth. Within 24 hours, the fundus descends 1 to 2 cm, and the size of the uterus is the same as during 20 weeks' gestation. By the sixth week, the uterus returns to its normal, nonpregnant state. What instructions does the nurse give to a patient who had postpartum hemorrhage and is prescribed warfarin (Coumadin) therapy? "Avoid: Feeding breast milk to the baby during the course of therapy." Taking naproxen (Anaprox) during the course of therapy." Taking aspirin (Ecotrin) for pain relief during the course of therapy." Using any products that contain alcohol during the course of therapy."

Eating large portions of green vegetables during the course of therapy." - ANSWERS-Taking naproxen (Anaprox) during the course of therapy." Taking aspirin (Ecotrin) for pain relief during the course of therapy." Using any products that contain alcohol during the course of therapy." Eating large portions of green vegetables during the course of therapy." Green leafy vegetables are good sources of vitamin K, which enhances blood clotting. Because warfarin (Coumadin) is used to dissolve a clot, green vegetables can retard its effects. Aspirin (Ecotrin) and naproxen (Anaprox) inhibit synthesis of clotting factors and prolong clotting time and thus aggravate the action of warfarin. Alcohol also enhances the clotting effect, so it, too, should be avoided. Breast milk can be given to the infant, because warfarin has no effect on lactation. p. 540 When reviewing a patient's medical reports, the nurse finds that the patient has submucosal uterine fibroids. Which postpartum complication of pregnancy is the patient likely to have? Placenta accreta Impaired lactation Vaginal hematomas Postpartum hemorrhage - ANSWERS-Placenta accreta Placenta accreta is a slight penetration of the placenta into the myometrium of the uterus. A patient who has submucosal fibroids has a higher risk of developing placenta accreta. Placenta

accreta can be diagnosed before birth using an ultrasound and magnetic resonance imaging (MRI). Submucosal fibroids do not have any effect on lactation. Therefore they do not pose a risk of impaired lactation in the patient. Vaginal hematomas are associated with forceps- assisted birth, episiotomy, or primigravidity. Submucosal uterine fibroids do not have any effect on the integrity of the vaginal walls. Therefore submucosal uterine fibroids do not cause vaginal hematomas. The patient's report suggests that the placenta is adherent to the uterine wall. This does not indicate that the patient is at risk for postpartum hemorrhage. p. 531 Upon assessing the CRIES neonatal postoperative pain scale findings, the nurse concludes that the infant is experiencing severe pain. What finding made the nurse conclude this? The infant wakes up frequently. The infant's skin has a pink complexion. The infant requires 40% oxygen support. The infant's Heart rate was 110 beats/min. - ANSWERS-The infant wakes up frequently. According to the CRIES scale, the infant is experiencing severe pain when he or she requires more than 30% oxygen support to maintain normal functioning. The normal heart rate of an infant is 110 beats/min. The heart rate increases when the infant cries. A pink complexion is a normal indication, so a pink complexion does not cause the nurse to conclude that the infant is in severe pain. p.619 While assessing a newborn, the nurse finds that the infant has slow movement of the eyes, hands, and legs. What could be the possible reason? The infant was: Breastfed regularly.

Given corn syrup regularly. Fed cow's milk regularly. Fed formula regularly. - ANSWERS-Fed formula regularly. Slow movement of the eyes, hands, and legs indicates slow neurologic and visual development in the infant. Essential fatty acids (EFAs) are needed for growth, neurologic development, and visual function in the infant, which may be lacking in infant formula. Breastfed infants do not experience such effects because human milk contains EFAs. Corn syrup solids are added to infant formulas to provide lactose and do not cause such effects in infants. Cow's milk contains vitamin A and B complex and is sufficient for neurologic and visual development of infants. The nurse tells a new mother, "Feeding in the first 3 days after childbirth is very important." What are the reasons behind this statement? It facilitates passing of meconium. It promotes growth spurts in babies. The milk during the first 3 days contains rich antibodies. The milk during the first 3 days contains rich proteins and fats. It helps establish flora in the intestine. - ANSWERS-It facilitates passing of meconium. The milk during the first 3 days contains rich antibodies.

It helps establish flora in the intestine. Colostrum is produced in the first 3 days after childbirth. Colostrum promotes the early passage of meconium (earliest stool of the infant), which consists of the material ingested when the baby is in the uterus. Colostrum contains high amounts of antibodies, which help develop immunity in infants. Colostrum is useful in establishing flora in the digestive tract of an infant and stimulates the immune system. Occurrence of growth spurts is not related to feeding of colostrum. Growth in infants may occur as long as breastfeeding is adequate. Colostrum is rich in proteins but low in fats. p. 639 Which suggestions should the nurse include when teaching about appropriate weight gain in pregnancy?. Underweight women should gain 12.5 to 18 kg. Overweight women should gain at least 7 to 11.5 kg. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale. In twin gestations, the weight gain recommended for a single fetus pregnancy should simply be doubled. Normal weight women should gain 11.5 to 16 kg. - ANSWERS-Underweight women should gain 12.5 to 18 kg. Overweight women should gain at least 7 to 11.5 kg. Adolescents are encouraged to strive for weight gains at the upper end of the recommended scale.

Normal weight women should gain 11.5 to 16 kg. The nurse is assessing a pregnant patient with an iron deficiency. On reviewing the patient's prescription, the nurse finds that the patient has been prescribed iron and folate supplements. Which foods should the nurse instruct the patient to include in the diet chart to prevent the adverse effects of iron and folate supplements? Cheeses Citrus fruits Whole grains Enriched breads - ANSWERS-Whole grains Iron and folate supplements decrease the absorption of zinc. Therefore a pregnant woman who has been prescribed iron and folate supplements should be encouraged to consume good sources of zinc on a daily basis. Liver, shellfish, meats, and whole grains are rich sources of zinc, so the nurse includes whole grains in the diet. Cheese contains high amount of calories and fat, so it should be consumed less during pregnancy and is not necessarily included in the diet. Citrus fruits are high in vitamin C and folate. Enriched breads have high iron content. Therefore these do not help in preventing the adverse effects of zinc and folate supplements. pp. 229, 238 The ultrasound scan of a pregnant woman in the second trimester shows an impairment in the development of the fetus's central nervous system. High intake of which food in the patient's diet might have caused this complication? Fish