HESI RN OB Exam ( Hesi Maternal Health )

The correct answer is: Macrosomic newborn.

Explanation:

Gestational diabetes mellitus (GDM) occurs when a woman develops high blood sugar levels during pregnancy, which can negatively impact both maternal and fetal health. The key risk for the fetus if euglycemia (normal blood sugar levels) is not maintained is macrosomia, which refers to a condition where the baby grows abnormally large. This can occur due to the fetus receiving excess glucose from the mother, which stimulates the fetal pancreas to produce more insulin. This results in excessive fetal growth, particularly an increase in fat stores, leading to macrosomia.

Macrosomic newborn:

Macrosomia is the greatest risk associated with uncontrolled gestational diabetes. When blood glucose levels are not controlled, the excess glucose crosses the placenta and stimulates the fetus's insulin production. This can cause the fetus to grow excessively large, a condition known as macrosomia. A macrosomic newborn can present significant complications during delivery, including:

Shoulder dystocia (difficulty delivering the shoulders)

Birth trauma due to the baby’s siz

Increased risk of cesarean delivery

Why other options are incorrect

Low birth weight:

Low birth weight is not typically associated with gestational diabetes. In fact, gestational diabetes usually leads to larger babies, not smaller ones. Low birth weight is more commonly associated with intrauterine growth restriction (IUGR), which can be caused by conditions such as preeclampsia, placental insufficiency, or maternal malnutrition, but not typically by gestational diabetes.

Preterm birth:

Preterm birth can be a risk in pregnancies with gestational diabetes, but it is not the greatest risk. Although gestational diabetes can increase the risk of preterm birth, macrosomia is a more significant and direct complication. Uncontrolled blood sugar can contribute to other pregnancy complications that might result in preterm birth, but the primary fetal risk remains macrosomia.

Cleft palate:

Cleft palate is not a typical complication of gestational diabetes. While certain congenital anomalies can occur in pregnancies with poorly controlled diabetes, cleft palate is more commonly associated with other risk factors, such as certain medications, genetic conditions, or maternal smoking. The greatest fetal risk from gestational diabetes remains related to excessive growth (macrosomia) rather than specific structural defects like a cleft palate.

Summary:

The greatest risk to the fetus in a pregnancy with gestational diabetes is macrosomia (a macrosomic newborn). This occurs when uncontrolled blood sugar leads to excessive fetal growth, which can result in complications during delivery and an increased risk of trauma.

The correct answer is: Biophysical profile (BPP)

Explanation:

The biophysical profile (BPP) is a comprehensive diagnostic test that combines an ultrasound and non-stress test (NST) to assess fetal well-being, particularly when there are concerns about fetal distress or difficulties in utero. It evaluates five parameters: fetal heart rate (via NST), fetal breathing movements, fetal body movements, fetal tone, and amniotic fluid volume. A BPP can help assess fetal oxygenation and overall health, guiding decisions about further interventions or delivery.

Given that the non-stress test already indicated potential fetal difficulties, the BPP is an appropriate next step to gain additional insight into the fetus's condition and to determine whether there is an urgent need for delivery.

Why the Other Choices Are Incorrect:

Ultrasound for fetal anomalies

While an ultrasound may be useful in diagnosing fetal anomalies, it is not the most appropriate test when the concern is fetal well-being or distress. The BPP is a more comprehensive assessment of the fetus's immediate condition, including factors such as fetal movement, heart rate, and amniotic fluid volume.

Maternal serum alpha-fetoprotein (AF) screening

Alpha-fetoprotein (AFP) screening is typically performed earlier in pregnancy, usually between 15 and 20 weeks gestation, to screen for neural tube defects and other fetal conditions. It is not a test that can provide immediate information about fetal well-being at 41 weeks, and it would not address the current concern of fetal difficulties.

Percutaneous umbilical blood sampling (PUBS)

PUBS is an invasive procedure that involves taking a blood sample from the umbilical cord to assess for fetal anemia or other blood disorders. It is generally reserved for situations where there is a specific need to investigate fetal blood conditions or chromosomal abnormalities, not for initial assessments of fetal distress. It carries some risk and is not the first-line diagnostic test for fetal well-being concerns.

Summary:

The Biophysical profile (BPP) (A) is the most appropriate test in this scenario because it provides comprehensive information about fetal well-being, including heart rate, movements, tone, and amniotic fluid, and helps guide decisions about the need for delivery or further intervention. The other options either focus on other issues or are not suited for immediate concerns regarding fetal distress or difficulties.

The correct answer is : Allow the child to have the stuffed toy in the tent.

Explanation:

When a child is hospitalized with croup and is placed in a mist tent, it is important to provide comfort and familiarity to help reduce anxiety and make the child feel more at ease in the hospital setting. A stuffed animal is often a source of comfort and can help with emotional support. There are no strict contraindications to having a stuffed animal in a mist tent, as long as the toy is clean and not at risk for becoming a source of infection.

In fact, maintaining emotional comfort is important for the child’s overall well-being, and allowing the child to keep their stuffed toy helps to achieve this. The toy can be washed at home later or sanitized, but it is generally safe to have it with the child in the tent.

Why the Other Answers Are Incorrect:

Spray the toy with disinfectant before placing it in the tent.

Disinfectants may not be suitable for stuffed animals, especially if they are made of materials that could be damaged by chemicals. Spraying disinfectant could harm the toy or make it unpleasant for the child. Instead, proper hygiene practices like washing the toy at home or using safe, child-friendly cleaning methods would be more appropriate.

Limit play with the stuffed toy when out of the tent.

Limiting play only when the child is out of the tent may be unnecessary. The primary concern is the risk of infection, and if the toy is clean and appropriately handled, there is no need to restrict play based on the child's location in the hospital.

 Ask the mother to wash the toy daily at home.

While it is important to keep the stuffed animal clean, asking the mother to wash it daily at home might be an impractical expectation, especially since the toy will likely be exposed to the mist in the hospital. Instead, focusing on allowing the toy in the tent, while ensuring it is cleaned properly when necessary, is more reasonable.

Summary:

Allowing the child to have the stuffed toy in the tent provides emotional comfort and reduces anxiety during the treatment of croup. Ensuring the toy is clean and maintaining good hygiene practices is key, but there is no need to take excessive precautions such as spraying disinfectants on it or limiting its use.

The correct answer is: Continue breastfeeding every 2 hours.

Explanation:

Breast engorgement occurs when the breasts become full, firm, and painful due to an increase in milk production, especially in the first few days postpartum. The most effective way to relieve engorgement is to ensure that the breasts are emptied regularly, which can be achieved by breastfeeding frequently. Breastfeeding every 2 hours helps stimulate milk production and ensures that milk is removed from the breasts, preventing further discomfort and reducing the risk of complications like mastitis.

Why the Other Choices Are Incorrect:

Skip a feeding to rest the breasts: Skipping a feeding can actually exacerbate engorgement. When milk is not removed from the breasts regularly, it can lead to further buildup of milk, increasing discomfort and the risk of developing mastitis or plugged ducts. Frequent breastfeeding is necessary to prevent engorgement from worsening.

Avoid pumping her breasts:

While excessive pumping can sometimes lead to overproduction and engorgement, if a mother is unable to breastfeed or if she needs to relieve some of the pressure, pumping in moderation can help. In general, it is encouraged to breastfeed frequently, but if additional milk removal is needed, pumping can be a useful option to relieve engorgement.

Decreased fluid intake for at least 24 hours:

Decreasing fluid intake is not an effective way to manage engorgement. Adequate hydration is essential for milk production, and restricting fluid intake can negatively impact milk supply. Proper hydration should be maintained.

Summary:

The best way to relieve breast engorgement is to continue breastfeeding every 2 hours (A). This helps to empty the breasts and reduce the discomfort caused by engorgement. Skipping feedings or reducing fluid intake are not recommended and can worsen the situation.

The correct answer is: Adequate folic acid during embryogenesis reduces the incidence of neural tube defects.

Explanation:

Folic acid, a form of vitamin B9, is crucial during pregnancy, especially in the early weeks of gestation when the neural tube (which eventually becomes the brain and spinal cord) is forming. Adequate intake of folic acid during this time significantly reduces the risk of neural tube defects (NTDs) such as spina bifida and anencephaly. This is the most well-established and important benefit of folic acid supplementation during pregnancy and is a key part of preventative perinatal care.

Why the Other Options Are Incorrect:

The risk for neonatal cerebral palsy increases with folic acid deficiencies during pregnancy. While folic acid is important for preventing neural tube defects, there is no strong evidence to support that a deficiency in folic acid directly causes cerebral palsy. Cerebral palsy is typically caused by other factors, including brain injury or abnormal brain development, not directly by folic acid deficiency.

Folic acid can significantly reduce the incidence of mental retardation. Folic acid supplementation primarily helps in preventing neural tube defects. There is no direct, strong evidence that folic acid deficiency during pregnancy significantly increases the risk of mental retardation. However, folic acid is important for general fetal development, and its role in the prevention of NTDs may indirectly contribute to overall neurodevelopmental health.

The incidence of congenital heart defects is related to folic acid intake deficiencies. While folic acid is important for proper fetal development, including neural tube closure, its direct role in preventing congenital heart defects is not as strongly supported by research as its role in preventing neural tube defects. The relationship between folic acid and congenital heart defects is less clear, and other factors such as genetic and environmental influences are more directly linked to congenital heart defects.

Summary:

The nurse should explain that adequate folic acid intake during early pregnancy is crucial for reducing the incidence of neural tube defects, which are among the most serious and preventable birth defects.

 The correct answers are:

Grunting heard with a stethoscope.

Diaphragmatic with chest retraction.

Chest breathing with nasal flaring.

Explanation:

Grunting heard with a stethoscope:

Grunting is an abnormal finding and indicates respiratory distress. It occurs when a newborn is trying to maintain lung volume and oxygenation. This can be seen in conditions like respiratory distress syndrome (RDS) or transient tachypnea of the newborn (TTN). Grunting requires further assessment and potentially urgent intervention.

Diaphragmatic with chest retraction:

Diaphragmatic breathing with chest retraction indicates that the newborn may be working harder to breathe, which suggests respiratory distress. Chest retractions are a sign that the infant is struggling to get enough air, and the respiratory effort may be insufficient. This requires immediate assessment and intervention.

Chest breathing with nasal flaring:

Nasal flaring is a sign of respiratory distress in newborns. It occurs when the infant's body is trying to take in more oxygen, often in response to labored breathing or low oxygen levels. Chest breathing in this context may indicate that the infant is having difficulty with ventilation, which, combined with nasal flaring, should be assessed further.

Why the Other Choices Are Incorrect:

Abdominal with synchronous chest movements:

This is a normal finding in newborns. Newborns typically use abdominal breathing, and their chest and abdomen move together in a synchronous manner. This is not a sign of distress and does not require further assessment.

Shallow with an irregular rhythm:

Shallow and irregular breathing is common in newborns. It is normal for newborns to have irregular, shallow breathing patterns during the first few hours of life. If the baby has periodic breathing (with pauses up to 20 seconds), it is usually benign and should not cause concern unless it lasts longer or is associated with other signs of distress.

Rate of 58 breaths per minute:

A respiratory rate of 58 breaths per minute is within the normal range for a newborn (30–60 breaths per minute). This is not an abnormal finding and does not require further assessment.

In summary, the nurse should focus on abnormal respiratory signs such as grunting, chest retractions, and nasal flaring, which indicate possible respiratory issues that need urgent evaluation.

The correct answer is: Squatting.

Explanation:

Squatting is a position that utilizes gravity to help with the descent of the baby during the second stage of labor. This position opens the pelvic outlet, increases the diameter of the pelvis, and allows for a more efficient use of gravity, which aids in the baby's movement through the birth canal. Squatting can also help enhance contractions and reduce the length of labor, especially for those who are able to maintain this position comfortably.

Why the Other Choices Are Incorrect:

Walking.

While walking can be beneficial in early labor to help stimulate contractions and encourage fetal descent, it is generally not the best position during the second stage of labor. Walking can be tiring and may not provide as much of a gravitational advantage as squatting when it comes to assisting the baby through the birth canal.

Kneeling.

Kneeling can also be helpful during labor because it allows the woman to work with gravity to position the baby, but it is not as effective as squatting in terms of maximizing gravity to assist in the baby’s descent. It may be beneficial in certain situations but does not provide as strong an advantage as squatting for the second stage of labor.

Lithotomy.

The lithotomy position (lying on the back with the legs in stirrups) is a common position used in many hospitals for delivery, but it does not take advantage of gravity as effectively as squatting or other upright positions. In fact, this position can restrict the pelvic diameter, potentially making labor more difficult and reducing the efficiency of contractions.

Summary:

Squatting during the second stage of labor allows for the best use of gravity to assist in the baby's descent and delivery. It opens the pelvis and facilitates more effective contractions, making it the most advantageous position among the options provided.

The correct answer is: Initiate oxygen via face mask at 8 to 10 L/min.

Explanation:

When a client is experiencing premature rupture of membranes (PROM), one of the risks is the potential development of infection, such as chorioamnionitis. An increasing maternal heart rate can be a sign of infection or fetal distress, as the body attempts to compensate for the developing issue. Administering oxygen helps ensure adequate oxygenation to the fetus, especially in cases where there may be fetal distress or infection. Oxygen can also help reduce the risk of fetal hypoxia due to the compromised uterine environment.

Why the other options are wrong:

Follow contact precautions when providing care.

Contact precautions are generally indicated when there is a risk of transmission of an infectious agent, especially if the client has an infection such as chorioamnionitis. While infection is a concern, it is not the immediate priority in this situation compared to ensuring fetal oxygenation and maternal well-being. Contact precautions may be necessary later if infection is confirmed.

Insert a urinary catheter to monitor hourly output.

Monitoring urine output is important in many situations to assess kidney function or fluid balance, especially in cases of infection or preeclampsia. However, an increasing maternal heart rate due to PROM is more indicative of a possible infection or fetal distress, and the priority should be to manage this with oxygenation rather than focusing on urinary output at this moment.

Encourage the client to push with the next contraction.

Pushing is not indicated at 34 weeks' gestation, especially in the context of PROM. Premature rupture of membranes can lead to preterm labor, but encouraging pushing without clear signs of full dilation and readiness for delivery could increase the risk of complications. This is not an appropriate response to the maternal tachycardia and is not aligned with standard management for a preterm labor scenario.

Summary:

The correct action in this scenario is to administer oxygen at 8-10 L/min via face mask to ensure that both the mother and fetus receive adequate oxygenation, which is crucial when there are signs of infection or fetal distress. Monitoring vital signs and continuing to assess the situation is essential, but oxygen is the immediate priority.

The correct answer is: The fetus can respond to sound by 24-weeks gestation.

Explanation:

At 24 weeks gestation, the fetus begins to respond to sounds, particularly louder, sudden noises. By 25 weeks, the fetus has developed the ability to hear external sounds and may show a response to them, such as jumping or moving when exposed to sudden sounds. This is a normal developmental milestone in fetal sensory development.

Why the Other Choices Are Incorrect:

Report the fetus's behavior to the healthcare provider.

There is no indication that the fetus's behavior is abnormal or concerning. Responding to external sounds, like a cooking utensil dropping, is a normal physiological reaction. Reporting this to the healthcare provider is unnecessary unless there are other symptoms or concerns that accompany it.

This is a demonstration of the fetus's acoustical reflex.

While it is true that the fetus can respond to sound, the term "acoustical reflex" typically refers to a specific type of reflex in response to loud sounds or certain frequencies. The behavior described (the baby "jumping" in response to noise) is more accurately a normal response to external auditory stimuli, rather than a reflex. The term "response to sound" is a more general and accurate description in this case.

It is a coincidence the fetus responded at the same time.

The fetus's response to a loud sound is not a coincidence. As mentioned, by 24 weeks, the fetus is able to respond to external stimuli like sound. It is a normal developmental milestone and not a random occurrence.

Summary:

The correct response is B. The fetus can respond to sound by 24-weeks gestation, as it provides accurate, evidence-based information that reassures the client about the normal development of the fetus's sensory capabilities.