Nursing Elites

1. At 31 weeks gestation, a client with a fundal height measurement of 25 cm is scheduled for a series of ultrasounds to be performed every two weeks. Which explanation should the nurse provide?

• A. Assessment for congenital anomalies
• B. Recalculation of gestational age
• C. Evaluation of fetal growth
• D. Determination of fetal presentation

Correct answer: C

Rationale: The correct answer is C: 'Evaluation of fetal growth.' A fundal height measurement smaller than expected may indicate intrauterine growth restriction (IUGR), requiring serial ultrasounds to monitor fetal growth. Assessing for congenital anomalies (choice A) is usually done through detailed anatomy scans earlier in pregnancy. Recalculating gestational age (choice B) is typically unnecessary at this stage unless there are concerns about accuracy. Determining fetal presentation (choice D) is usually done closer to term to plan for the mode of delivery.

2. During a prenatal visit, for which of the following clients should the nurse auscultate the fetal heart rate?

• A. A client who has an ultrasound confirming a molar pregnancy
• B. A client who has a crown-rump length corresponding to 7 weeks gestation
• C. A client who has a positive urine pregnancy test 1 week after missed menses
• D. A client who has felt quickening for the first time

Correct answer: D

Rationale: The correct answer is D because feeling quickening typically occurs around 18-20 weeks of gestation, indicating fetal movement. This is an appropriate time to auscultate the fetal heart rate. Choice A is incorrect because a molar pregnancy is not a viable pregnancy, and auscultating the fetal heart rate in this case is not applicable. Choice B is incorrect because a crown-rump length of 7 weeks gestation is too early for fetal heart rate auscultation. Choice C is incorrect because a positive urine pregnancy test alone does not indicate the appropriate timing for fetal heart rate auscultation.

3. Which neonatal complications are associated with hypertension in the mother?

• A. Intrauterine growth restriction (IUGR) and prematurity.
• B. Seizures and cerebral hemorrhage.
• C. Hepatic or renal dysfunction.
• D. Placental abruption and DIC.

Correct answer: A

Rationale: Neonatal complications associated with maternal hypertension are primarily due to placental insufficiency. The correct answer is A, which includes Intrauterine Growth Restriction (IUGR) and prematurity. These complications arise from inadequate blood flow to the fetus, leading to growth restriction and premature birth. Choices B, seizures, and cerebral hemorrhage are more commonly maternal complications rather than neonatal ones. Choice C, hepatic or renal dysfunction, pertains to maternal complications of hypertensive disorders in pregnancy, not neonatal issues. Choice D, placental abruption, and Disseminated Intravascular Coagulation (DIC) are conditions linked to maternal morbidity and mortality, not neonatal complications.

4. Examination reveals that the laboring client's cervix is dilated to 2 centimeters, 70% effaced with the presenting part at -2 station. The client tells the nurse, 'I need my epidural now, this hurts.' The nurse's response to the client is based on which information?

• A. The client will need to be catheterized before the epidural can be administered.
• B. Administering an epidural at this point would slow down the labor process.
• C. The client should be dilated to at least 8 centimeters before receiving an epidural.
• D. The baby needs to be at a zero station before an epidural can be administered.

Correct answer: B

Rationale: Administering an epidural too early in labor, especially at 2 cm dilation, can slow down the progress of labor. It is usually recommended to wait until labor is more established. Choice A is incorrect because catheterization is not a prerequisite for epidural administration. Choice C is incorrect as waiting until 8 cm dilation is not a standard requirement for epidural administration. Choice D is incorrect because the baby's station being at zero is not a strict criterion for epidural administration.

5. A woman who is 38 weeks gestation is receiving magnesium sulfate for severe preeclampsia. Which assessment finding warrants immediate intervention by the nurse?

• A. Dizziness while standing
• B. Sinus tachycardia
• C. Lower back pain
• D. Absent patellar reflexes

Correct answer: D

Rationale: The correct answer is D: Absent patellar reflexes. Absent patellar reflexes can indicate magnesium toxicity, a serious condition that requires immediate intervention to prevent respiratory depression or cardiac arrest. Dizziness while standing (choice A) is common in pregnancy but does not specifically indicate magnesium toxicity. Sinus tachycardia (choice B) can be a normal response to magnesium sulfate but does not indicate toxicity. Lower back pain (choice C) is common in pregnancy and not specifically associated with magnesium toxicity.

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