HESI Maternity Test Bank

Correct Answer: A

Rationale: In a client with preeclampsia, 3+ deep tendon reflexes and hyperreflexia are indicative of severe preeclampsia. These neurological signs suggest an increased risk for seizures, making option A the most indicative of an impending convulsion.

Correct Answer: A

Rationale: Having the client empty her bladder before measuring the fundal height is essential to ensure an accurate measurement. A full bladder can impact the fundal height measurement by displacing the uterus and affecting the accuracy of the assessment.

Correct Answer: A

Rationale: In this scenario, the best intervention is to ask the mother to stop feeding, comfort the infant, and then assist her in helping the baby latch on. Stopping the feeding and providing comfort can reduce the infant's frustration and create a calmer environment for successful breastfeeding.

Correct Answer: A

Rationale: During breastfeeding, insulin needs often decrease due to the metabolic demands of milk production. Therefore, the nurse should inform the client that this decrease in insulin requirements is a normal response to breastfeeding. It is essential for healthcare providers to educate clients about this physiological change to prevent unnecessary concerns or adjustments to insulin therapy.

Correct Answer: D

Rationale: Involving the family in the decision of who will stay during the suturing procedure supports their comfort and participation in the child's care, promoting a sense of control and family-centered care.