Nursing Elites

1. A client at 34 weeks gestation comes to the birthing center complaining of vaginal bleeding that began one hour ago. The nurse's assessment reveals approximately 30ML of bright red vaginal bleeding, fetal heart rate of 130 - 140 beats per minute, no contractions, and no complaints of pain. What is the most likely cause of this client's bleeding?

• A. Abruptio Placenta
• B. Placenta Previa
• C. Normal bloody show indicating induction of labor
• D. A ruptured blood vessel in the vaginal vault

Correct answer: B

Rationale: Placenta previa, a condition where the placenta covers the cervix, can cause painless, bright red vaginal bleeding in the third trimester. In this scenario, the absence of contractions and pain, along with the presence of significant bright red bleeding, is more indicative of placenta previa rather than abruptio placenta or a ruptured vessel. A normal bloody show typically occurs closer to the onset of labor and is not associated with the amount of bleeding described in the question.

2. A client who is at 24 weeks of gestation is receiving teaching about expected changes during pregnancy. Which of the following information should the nurse include?

• A. Your stomach will empty rapidly
• B. You should expect your uterus to double in size
• C. You should anticipate nasal stuffiness
• D. Your nipples will become lighter in color

Correct answer: C

Rationale: Nasal stuffiness is a common symptom during pregnancy due to increased blood flow and hormonal changes. This symptom is caused by the increased blood volume and hormonal changes that lead to swelling of the nasal passages. Choices A, B, and D are incorrect. Stomach emptying rate does not significantly change during pregnancy; the uterus does not double in size at 24 weeks but rather grows steadily, and nipples typically darken in color due to increased pigmentation.

3. Chromosomes contain thousands of segments called:

• A. nuclei.
• B. nodes.
• C. capillaries.
• D. genes.

Correct answer: D

Rationale: Chromosomes are structures composed of DNA and genes. Genes are the functional segments within chromosomes that encode specific traits and characteristics. The other choices ('nuclei,' 'nodes,' 'capillaries') do not accurately describe the segments found within chromosomes and are unrelated to their structure or function.

4. Monozygotic (MZ) twins share _________ percent of their genes.

• A. 100
• B. 75
• C. 50
• D. 25

Correct answer: A

Rationale: Monozygotic (MZ) twins share 100% of their genes because they originate from the same fertilized egg that splits into two, resulting in identical genetic material for both twins. Choice B (75%) is incorrect as it implies a partial genetic similarity, which is not the case for MZ twins. Choice C (50%) is incorrect as it suggests half of the genes are shared, which is applicable to dizygotic (DZ) twins, not MZ. Choice D (25%) is incorrect as it indicates minimal genetic sharing, which is not true for MZ twins.

5. A client at 30 weeks gestation reports that she has not felt the baby move in the last 24 hours. Concerned, she arrives in a panic at the obstetric clinic where she is immediately sent to the hospital. Which assessment warrants immediate intervention by the nurse?

• A. Fetal Heart rate 60 beats per minute
• B. Ruptured amniotic membrane
• C. Onset of uterine contractions
• D. Leaking amniotic fluid

Correct answer: A

Rationale: A fetal heart rate of 60 beats per minute is significantly below the normal range (110-160 bpm) and indicates fetal distress, requiring immediate intervention. This low heart rate can be a sign of fetal compromise or distress, necessitating urgent evaluation and intervention to ensure the well-being of the fetus. Choices B, C, and D do not indicate immediate fetal distress requiring urgent intervention. Ruptured amniotic membrane, onset of uterine contractions, and leaking amniotic fluid are important assessments but do not present an immediate threat to the fetus's life like a severely low fetal heart rate.

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