Nursing Elites

1. A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28 weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg subcutaneously to stop her labor contractions. The LPN/LVN plans to monitor for which primary side effect of terbutaline sulfate?

• A. Drowsiness and bradycardia.
• B. Depressed reflexes and increased respirations.
• C. Tachycardia and a feeling of nervousness.
• D. A flushed, warm feeling and a dry mouth.

Correct answer: C

Rationale: The primary side effects of terbutaline sulfate are related to its beta-adrenergic effects. Tachycardia and nervousness are common side effects of terbutaline sulfate. Tachycardia is expected due to the drug's beta-agonist properties, while nervousness can result from the stimulation of beta-adrenergic receptors. It is crucial to monitor the client for these side effects to ensure early recognition and appropriate management.

2. A new mother who is breastfeeding her 4-week-old infant and has type 1 diabetes reports that her insulin needs have decreased since the birth of her child. Which action should the nurse implement?

• A. Inform her that a decreased need for insulin occurs while breastfeeding.
• B. Counsel her to increase her caloric intake.
• C. Advise the client to breastfeed more frequently.
• D. Schedule an appointment for the client with the diabetic nurse educator.

Correct answer: A

Rationale: The correct answer is A. 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. Choice B is incorrect as increasing caloric intake is not directly related to the decrease in insulin needs during breastfeeding. Choice C is incorrect as advising the client to breastfeed more frequently does not address the issue of decreased insulin needs. Choice D is incorrect as scheduling an appointment with the diabetic nurse educator is not necessary at this point since the decreased need for insulin is a common physiological response to breastfeeding.

3. When can a woman who thinks she may be pregnant use a home pregnancy test to diagnose pregnancy?

• A. A home pregnancy test can be used right after your first missed period.
• B. These tests are most accurate after you have missed your second period.
• C. Home pregnancy tests often give false positives and should not be trusted.
• D. The test can provide accurate information when used right after ovulation.

Correct answer: A

Rationale: The correct answer is A. Home pregnancy tests detect hCG, a hormone produced during pregnancy, and are most accurate after the first missed period when hCG levels are higher. Testing too early may result in a false negative. Waiting until after the first missed period increases the reliability of the test results. Choice B is incorrect as waiting until after the second missed period is unnecessary and may delay seeking appropriate healthcare. Choice C is incorrect as home pregnancy tests are generally reliable when used correctly. Choice D is incorrect because ovulation occurs before the period, and testing immediately after ovulation may not provide accurate results.

4. A 6-month-old child who had a cleft-lip repair has elbow restraints in place. What nursing intervention should the nurse plan to implement?

• A. Obtain the healthcare provider’s advice as to when the restraints should be removed.
• B. Remove restraints one at a time to provide range of motion exercises.
• C. Record observation of the restraints q2h and ensure that they are in place at all times.
• D. Remove restraints q4h for 30 minutes and place gloves on the child’s hands.

Correct answer: B

Rationale: Removing restraints one at a time for range of motion exercises prevents muscle stiffness and allows assessment of the skin.

5. A mother who is breastfeeding her baby receives instructions from the nurse. Which instruction is most effective to prevent nipple soreness?

• A. Wear a cotton bra.
• B. Increase nursing time gradually.
• C. Correctly place the infant on the breast.
• D. Manually express a small amount of milk before nursing.

Correct answer: C

Rationale: The most effective instruction to prevent nipple soreness when breastfeeding is to correctly place the infant on the breast. Proper latch-on techniques ensure that the baby is properly positioned, reducing the risk of nipple soreness. When the baby is positioned correctly, they can nurse effectively without causing discomfort to the mother.

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