HESI RN OB Exam ( Hesi Maternal Health )

The correct answer is : Rho(D) immune globulin prevents maternal antibody formation for future Rh-positive babies.

Explanation:

Rho(D) immune globulin (also known as Rhogam) is administered to Rh-negative mothers who deliver Rh-positive babies to prevent the development of antibodies against Rh-positive blood cells. If the mother becomes sensitized to Rh-positive blood cells, these antibodies can cross the placenta during future pregnancies and attack the red blood cells of an Rh-positive fetus, leading to hemolytic disease of the newborn, a potentially dangerous condition. By administering Rho(D) immune globulin, the nurse helps prevent the formation of these antibodies, thereby protecting future pregnancies.

Why the Other Answers Are Incorrect:

The R-positive factor from the fetus threatens her blood cells.

This statement is inaccurate because the Rh-positive factor in the fetus does not threaten the mother’s blood cells. The concern is that the Rh-negative mother may form antibodies against the Rh-positive cells of the fetus, which can affect future pregnancies, not her current blood cells.

The mother should receive Rho(D) immune globulin when the baby is Rh-negative.

This is incorrect because Rho(D) immune globulin is only needed for Rh-negative mothers who deliver Rh-positive babies. If the baby is Rh-negative, there is no risk of Rh incompatibility, and Rho(D) immune globulin is not necessary.

Rho(D) immune globulin is not necessary unless all pregnancies are Rh-positive.

This is not accurate. Even if the current baby is Rh-positive, Rho(D) immune globulin is important to prevent sensitization, regardless of whether future pregnancies are Rh-positive. The goal is to prevent the formation of antibodies that could harm future Rh-positive babies.

Summary:

Rho(D) immune globulin is important for Rh-negative mothers who deliver Rh-positive infants because it prevents the development of antibodies that could harm future Rh-positive pregnancies. By explaining this to the patient, the nurse can help her understand the importance of receiving this treatment.

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:

Admission weight of 4 pounds, 15 ounces (2244 grams)

Head to heel length of 17 inches (42.5 cm)

Frontal occipital circumference of 12.5 inches (31.25 cm)

Explanation:

Small for gestational age (SGA) refers to newborns whose weight, length, or head circumference falls below the 10th percentile for their gestational age. A gestational age of 40 weeks indicates full-term status, but for a neonate to be classified as SGA, certain measurements must be assessed.

Admission weight of 4 pounds, 15 ounces (2244 grams):

This weight is below the typical range for a full-term neonate, indicating that the baby may be SGA. The normal birth weight for a full-term infant is generally between 5.5 to 8.8 pounds (2500 to 4000 grams), so a weight of 2244 grams is considered low for a full-term infant.

Head to heel length of 17 inches (42.5 cm):

This length is shorter than the typical range for a full-term newborn, indicating that the infant may be SGA. The average length of a full-term infant is usually around 19-21 inches (48-53 cm).

Frontal occipital circumference of 12.5 inches (31.25 cm):

A smaller head circumference than average for a full-term infant may also suggest SGA. A typical head circumference for a full-term newborn is around 13.5-14 inches (34-36 cm).

Why the Other Choices Are Incorrect:

Skin smooth with visible veins and abundant vernix:

These are typical findings for a full-term neonate and do not indicate SGA. SGA infants often have dry, peeling skin, and less vernix than full-term infants.

Anterior plantar crease and smooth heel surfaces:

These are normal findings in a full-term neonate, indicating typical gestational maturity and not suggesting SGA.

Full flexion of all extremities in resting supine position:

Full flexion of the extremities is typical of a full-term newborn and does not indicate SGA. SGA infants may appear less flexed, with looser muscle tone.

Summary:

To determine if a neonate is small for gestational age (SGA), the nurse should focus on abnormal physical measurements, such as a low admission weight (A), short length (B), and smaller head circumference (C). The other findings listed are typical for a full-term neonate and do not suggest SGA.

The correct answer is: Abdominal ultrasound.

Explanation:

Bright red, painless vaginal bleeding during the second or third trimester of pregnancy is a key symptom of placenta previa, a condition where the placenta is implanted low in the uterus, covering or being close to the cervical os. Abdominal ultrasound is the diagnostic procedure of choice to confirm the location of the placenta and assess whether it is indeed covering the cervical opening. This will help the healthcare provider determine the severity of the condition and the appropriate plan of care, including whether a cesarean section may be required.

Why the Other Choices Are Incorrect:

Contraction stress test.

A contraction stress test (CST) evaluates the fetus's response to uterine contractions and is typically used to assess fetal well-being, especially in cases of suspected fetal distress. It is not appropriate in this situation, where the concern is vaginal bleeding rather than fetal heart rate or stress.

Lecithin-sphingomyelin ratio.

The lecithin-sphingomyelin (L/S) ratio is a test used to assess fetal lung maturity, typically performed in cases of preterm labor. It is not relevant in this situation because the priority is determining the cause of the bleeding (such as placenta previa or placental abruption), not fetal lung maturity.

Internal fetal monitoring.

Internal fetal monitoring, such as using a fetal scalp electrode or intrauterine pressure catheter, is generally used to assess fetal heart rate and uterine contractions during labor, particularly if external monitoring is inadequate. It is not appropriate as the initial diagnostic tool for vaginal bleeding, as the first priority is determining the cause of the bleeding.

Summary:

The best diagnostic procedure for a client presenting with bright red, painless vaginal bleeding at 28 weeks gestation is abdominal ultrasound (C), as it helps determine if placenta previa is present. The other procedures are not suitable for this scenario and would not address the immediate concern of diagnosing the cause of the bleeding.

The correct answer is: Striae gravidarum.

Explanation 

Striae gravidarum, commonly known as stretch marks, are a permanent skin change that can occur during pregnancy. These marks appear as streaks on the skin, typically on the abdomen, breasts, thighs, or hips, and result from the skin stretching to accommodate the growing fetus. While the marks may fade and become less noticeable over time, they do not completely disappear.

Why the Other Choices Are Incorrect:

 Chloasma: Also known as the "mask of pregnancy," chloasma refers to darkened patches of skin, typically on the face, due to increased melanin production during pregnancy. These patches often fade or disappear after childbirth, especially with appropriate sun protection.

 Vascular spiders: These are small, red, spider-like blood vessels that can develop on the skin during pregnancy due to increased blood flow. They may disappear or fade after delivery, but they are not permanent.

 Pruritus: Pruritus (itching) can occur during pregnancy due to hormonal changes, stretching skin, or liver conditions. It is generally a temporary condition that resolves after delivery, although some women may experience persistent itching due to conditions like cholestasis of pregnancy.

Summary:

Striae gravidarum (A) are the only skin change that remains permanent after pregnancy. Other changes like chloasma, vascular spiders, and pruritus tend to resolve after childbirth.

The correct answer is: Recommend increasing dietary iron-rich foods.

Explanation:

A hemoglobin level of 9.5 mg/dL in early pregnancy indicates mild anemia. Iron supplementation is commonly prescribed to help improve hemoglobin levels, and dietary changes are also an important part of treatment. The practical nurse should recommend that the client increase her intake of iron-rich foods such as red meat, poultry, fish, leafy green vegetables, legumes, and iron-fortified cereals. This supports the effectiveness of the prescribed oral supplement and promotes overall maternal and fetal health.

Why the Other Choices Are Incorrect:

Ask the client if she has been experiencing constipation:

While constipation can be a side effect of oral iron supplements, it is not the most important initial teaching point. The focus should be on helping the client understand how to support iron absorption and improve her anemia.

Suggest that she should avoid citrus fruits when taking the iron:

This is incorrect. Citrus fruits, which are high in vitamin C, actually enhance iron absorption. Clients are often encouraged to take iron supplements with orange juice or other vitamin C-rich foods to improve effectiveness.

Explain that she should report stools that are dark green and sticky:

Dark stools are a common and harmless side effect of oral iron supplementation and do not need to be reported unless accompanied by other symptoms like abdominal pain or bleeding. This teaching could cause unnecessary worry.

Summary:

The most appropriate action is to recommend increasing dietary iron-rich foods (C), as this complements the prescribed oral supplement and addresses the client's low hemoglobin level. The other options either provide incorrect guidance or focus on less urgent aspects of care.

The correct answer is: Apply counter pressure against the sacrum.

Explanation:

Back labor, which typically occurs when the baby is in a posterior position (with the back of the baby against the mother's back), often causes intense pain in the lower lumbar-sacral region. Counter pressure applied to the sacrum can provide significant relief by alleviating the pressure from the baby's position and helping to reduce pain. The nurse can use the heel of the hand or a fist to apply firm pressure to the lower back.

Why the Other Choices Are Incorrect:

 Assist the client in guided imagery: While guided imagery can be an effective technique for relaxation and pain management, it is not specifically helpful for relieving the physical discomfort caused by back labor. The most immediate and effective intervention for back pain is counter pressure.

Encourage pant-blow breathing techniques: Pant-blow breathing is typically used for managing the urge to push or during the second stage of labor to prevent uncontrolled pushing. It does not address the specific pain relief needed for back labor, which requires physical interventions like counter pressure.

Perform effleurage on the abdomen: Effleurage involves light, circular abdominal massage, which is often used to relieve general labor pain, but it does not specifically target the pain from back labor. It may provide some comfort, but counter pressure to the sacrum is more effective for back pain.

Summary:

The most effective action for relieving the intense pain of back labor is to apply counter pressure against the sacrum (D), as it directly addresses the discomfort caused by the baby's posterior position. Other techniques may offer general relief but are not as targeted for this specific type of pain.

The correct answer is: Tell the client that monitoring and medication management during detoxification is best provided in the hospital.

Explanation:

When a client is going through alcohol detoxification, it is crucial that they receive proper medical monitoring and medication management due to the potential for severe withdrawal symptoms such as seizures, delirium tremens, and autonomic instability. These symptoms can be life-threatening, so hospitalization is often necessary for the client's safety. The practical nurse (PN) should provide factual and clear information about the need for hospitalization, highlighting the medical rationale behind the decision rather than simply focusing on the emotional aspects or family wishes.

Why the Other Choices Are Incorrect:

Listen attentively to the client's expression of anger, then support the family's wish that the client be hospitalized:

While it is important to listen to the client's concerns and emotions, simply supporting the family's wishes without offering a rational explanation for the hospitalization does not adequately address the medical necessity. The PN should provide a clear medical reason for why hospitalization is necessary, rather than just aligning with the family’s perspective.

Explain to the client that his family cares about him and wants him to be hospitalized during detoxification:

While it is important to acknowledge the family's concern, this response does not provide the necessary medical information the client needs to understand why hospitalization is essential. Focusing on the emotional aspect may not help the client recognize the importance of detoxification under medical supervision.

Use a mater-of-fact manner to inform the client that hospitalization is necessary during detoxification:

Although direct and clear communication is important, the client may be feeling defensive, angry, or scared. A more empathetic and informative approach that includes explanation of the medical reasons for hospitalization is more likely to help the client understand and accept the decision.

Summary:

The most effective response is to tell the client that monitoring and medication management during detoxification is best provided in the hospital (B). This provides the client with factual, medically sound reasons for the need for hospitalization, which is essential for their safety during detoxification. The other responses do not adequately provide the medical justification needed for the client to understand the necessity of hospitalization.

The correct answer is: Flat nasal bridge.

Explanation:

Fetal Alcohol Syndrome (FAS) is a condition caused by prenatal alcohol exposure, and it is characterized by several physical and neurological features. One of the hallmark physical features of FAS is a flat or short nasal bridge. This occurs as part of the craniofacial abnormalities often seen in infants with FAS. Other typical features include small palpebral fissures (narrowed eyes), thin upper lip, and a smooth philtrum (the groove between the nose and the upper lip).

Why the Other Choices Are Incorrect:

An extra digit on the left hand. An extra digit (polydactyly) is not typically associated with FAS. It is more commonly a congenital anomaly that can occur due to genetic factors or other environmental influences, but it is not a characteristic feature of fetal alcohol exposure.

Asymmetrical bulging fontanels. Asymmetrical bulging fontanels may indicate other concerns such as intracranial hemorrhage or hydrocephalus, but it is not a typical finding of FAS. FAS involves craniofacial abnormalities but not usually issues with the fontanels themselves.

Corneal clouding. Corneal clouding is associated with certain genetic disorders, such as mucopolysaccharidoses, but it is not characteristic of FAS. In FAS, the primary concerns are related to facial dysmorphology, growth deficiencies, and neurodevelopmental delays, not eye abnormalities like corneal clouding.

Summary:

The flat nasal bridge is the most characteristic finding of Fetal Alcohol Syndrome (FAS), which is caused by maternal alcohol consumption during pregnancy. Other signs of FAS can include growth retardation, developmental delay, and distinctive facial features such as a thin upper lip and smooth philtrum.