Nursing Elites

1. A 17-year-old client gave birth 12 hours ago. She states that she doesn't know how to care for her baby. To promote parent-infant attachment behaviors, which intervention should the nurse implement?

• A. Ask if she has help to care for the baby at home
• B. Provide a video on newborn safety and care
• C. Explore the basis of fears with the client
• D. Encourage rooming in while in the hospital

Correct answer: D

Rationale: Encouraging rooming in while in the hospital is the most appropriate intervention to promote parent-infant attachment behaviors. Rooming in allows the mother to stay with her baby continuously, facilitating bonding and providing the opportunity for the mother to learn how to care for her baby with the nurse's support. Asking if she has help at home (Choice A) does not directly address promoting attachment behaviors. Providing a video on newborn safety and care (Choice B) may offer information but does not actively facilitate immediate bonding. Exploring the basis of fears (Choice C) is important but may not directly address promoting attachment behaviors as effectively as encouraging rooming in.

2. A 38-week primigravida is admitted to labor and delivery after a non-reactive result on a non-stress test (NST). The nurse begins a contraction stress test (CST) with an oxytocin infusion. Which finding is most important for the nurse to report to the healthcare provider?

• A. A pattern of fetal late decelerations.
• B. Fetal heart rate accelerations with fetal movement.
• C. Absence of uterine contractions within 20 minutes.
• D. Spontaneous rupture of membranes.

Correct answer: A

Rationale: The correct answer is A: A pattern of fetal late decelerations. Late decelerations during a contraction stress test are concerning as they indicate uteroplacental insufficiency, which can pose a risk to fetal well-being. Reporting this finding to the healthcare provider is crucial for prompt intervention. Choice B, fetal heart rate accelerations with fetal movement, is a reassuring sign of fetal well-being and does not raise immediate concerns. Choice C, absence of uterine contractions within 20 minutes, may require further assessment but is not as critical as late decelerations. Choice D, spontaneous rupture of membranes, is important but not the most immediate concern during a contraction stress test.

3. An individual’s phenotype reflects both genetic and environmental influences.

• A. phenotype
• B. chromosome
• C. allele
• D. genotype

Correct answer: A

Rationale: The correct answer is A: phenotype. A phenotype is the observable characteristics of an individual, which result from the interaction of their genotype with the environment. This interaction between genetics and the environment determines how genes are expressed and how traits are manifested in an individual. Choices B, C, and D are incorrect because chromosomes, alleles, and genotypes are components of an individual's genetic makeup, but they do not directly reflect the observable traits influenced by both genetics and the environment.

4. A perinatal nurse is caring for a woman in the immediate postpartum period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause of this bleeding?

• A. Uterine atony.
• B. Uterine inversion.
• C. Vaginal hematoma.
• D. Vaginal laceration.

Correct answer: A

Rationale: Uterine atony is significant hypotonia of the uterus and is the leading cause of postpartum hemorrhage. It results in the inability of the uterus to contract effectively after delivery, leading to excessive bleeding. Uterine inversion is a rare but serious complication that involves the turning inside out of the uterus, leading to hemorrhage, but it is not the most likely cause of profuse bleeding in this scenario. Vaginal hematoma may cause bleeding but is typically associated with pain as a primary symptom rather than profuse bleeding. Vaginal lacerations can cause bleeding, but in the presence of a firm, contracted uterine fundus, uterine atony is a more likely cause of ongoing profuse bleeding in the postpartum period.

5. A client is preparing to administer methylergonovine 0.2 mg orally to a client who is 2 hr postpartum and has a boggy uterus. For which of the following assessment findings should the nurse withhold the medication?

• A. Blood pressure 142/92 mm Hg
• B. Urine output 100 mL in 1 hr
• C. Pulse 58/min
• D. Respiratory rate 14/min

Correct answer: A

Rationale: The correct answer is A. Methylergonovine can increase blood pressure, so it should be withheld if the client has hypertension. A blood pressure reading of 142/92 mm Hg indicates hypertension and is a contraindication for administering methylergonovine. Choices B, C, and D are within normal limits and not contraindications for administering this medication. Urine output, pulse rate, and respiratory rate are not factors that determine the appropriateness of administering methylergonovine in this situation.

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