Nursing Elites

1. A laboring client is experiencing late decelerations. Which position should she be placed in?

• A. left lateral
• B. lithotomy
• C. semi-Fowler's
• D. right lateral

Correct answer: A

Rationale: The correct answer is the left lateral position. Placing the laboring client in the left lateral position is beneficial because it promotes blood flow to the placenta. Late decelerations indicate potential issues with fetal oxygenation, and changing the position to left lateral can help improve placental perfusion. Choices B, C, and D are incorrect because lithotomy, semi-Fowler's, and right lateral positions do not specifically address the need for improved blood flow to the placenta in cases of late decelerations.

2. A nurse is assisting with developing a plan of care for an older client to help maintain an adequate sleep pattern. Which action should the nurse suggest be included in the plan?

• A. Encouraging bedtime reading or listening to music
• B. Encouraging at least one daytime nap
• C. Discouraging the use of a nightlight at bedtime
• D. Discouraging social interaction, particularly at bedtime

Correct answer: A

Rationale: To help maintain an adequate sleep pattern in older clients, it is essential to include activities that promote relaxation and a conducive sleep environment. Encouraging bedtime reading or listening to music can help the client unwind and prepare for sleep. Daytime naps should be discouraged to ensure a better nighttime sleep. Social interaction, especially positive interactions, can be beneficial and should not be discouraged. The use of a nightlight can create a safe and comfortable environment for the client, so it should not be discouraged unless specifically contraindicated.

3. A client in labor complains of back discomfort. Which position will best aid in relieving the discomfort? What position should the nurse encourage the mother to assume?

• A. Prone
• B. Standing
• C. Supine
• D. Hands and knees

Correct answer: D

Rationale: During back labor, when the back of the fetal head puts pressure on the woman's sacral promontory, the hands-and-knees position is encouraged. This position helps the fetus move away from the sacral promontory, reducing back pain and enhancing the internal-rotation mechanism of labor. A prone position would be difficult for the woman to assume and not helpful in relieving back discomfort. The supine position is risky due to supine hypotension, while standing may increase pressure, worsening backache.

4. What is the most appropriate intervention for a client with suspected genitourinary trauma and visible blood at the urethral meatus?

• A. Insertion of a Foley catheter.
• B. In-and-out catheter specimen for urinalysis.
• C. A voided urine specimen for urinalysis.
• D. A urologist consult.

Correct answer: D

Rationale: A urologist consult is the most appropriate intervention for a client with visible blood at the urethral meatus and suspected genitourinary trauma. This specialist can evaluate the extent of the trauma and provide the necessary treatment. Foley catheter insertion (Choice A) and in-and-out catheter specimen for urinalysis (Choice B) are contraindicated in the presence of genitourinary trauma as they can worsen the injury. While a voided urine specimen for urinalysis (Choice C) may be ordered by the physician, it does not address the specific management needed for genitourinary trauma. Therefore, a urologist consult is the best option in this scenario.

5. A nurse is preparing to screen a client's vision with the use of a Snellen chart. The nurse uses which technique?

• A. Tests the right eye, then tests the left eye, and finally tests both eyes together
• B. Assesses both eyes together, then assesses the right and left eyes separately
• C. Asks the client to stand 40 feet from the chart and read the largest line on the chart
• D. Asks the client to stand 40 feet from the chart and read the line that can be read 200 feet away by someone with unimpaired vision

Correct answer: A

Rationale: To test visual acuity with the use of a Snellen chart, the nurse places the chart in a well-lit spot at the client's eye level, with the client positioned exactly 20 feet from the chart. The client shields one eye at a time with an opaque card during the test. After testing each eye separately, both eyes are assessed together. The client is asked to read the smallest line of letters visible and encouraged to read the next smallest line as well. Therefore, option A is correct as it describes the correct technique of testing one eye at a time before assessing both eyes together. Option B is incorrect as it assesses both eyes together first, which is not the standard procedure. Options C and D are incorrect as they suggest standing 40 feet from the chart, which contradicts the standard distance of 20 feet for a Snellen chart test.

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