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. The healthcare provider is planning care for a client at 30 weeks gestation who is experiencing preterm labor. Which medication is most important in preventing this fetus from developing respiratory distress syndrome?

• A. Ampicillin 1 gram IV push every 8 hours
• B. Betamethasone 12 mg deep IM
• C. Terbutaline 0.25 mg subcutaneously every 15 minutes for 3 doses
• D. Butorphanol tartrate 1 mg IV push every 2 hours as needed

Correct answer: B

Rationale: Betamethasone is a corticosteroid given to stimulate fetal lung maturity and reduce the risk of respiratory distress syndrome in preterm infants. Ampicillin (Choice A) is an antibiotic and does not prevent respiratory distress syndrome. Terbutaline (Choice C) is a tocolytic used to inhibit contractions and does not directly prevent respiratory distress syndrome. Butorphanol tartrate (Choice D) is an opioid analgesic and does not have a role in preventing respiratory distress syndrome in preterm infants.

3. When discussing risk factors for gestational diabetes mellitus (GDM) with a group of pregnant clients, which ethnicity should the nurse identify as having the lowest incidence of GDM?

• A. Asian
• B. Non-Hispanic White American
• C. Hispanic
• D. African American

Correct answer: B

Rationale: Non-Hispanic White Americans have the lowest incidence of gestational diabetes mellitus (GDM) compared to other ethnicities. This is because GDM is more prevalent among certain ethnic groups, such as Asian, Hispanic, and African American populations. Asian individuals have an increased risk of developing GDM due to genetic factors, while Hispanic and African American populations have higher incidences of GDM due to lifestyle and genetic predispositions. Therefore, the correct answer is B, as Non-Hispanic White Americans generally have a lower risk of developing GDM.

4. A client who is 24 weeks gestation arrives at the clinic reporting swollen hands. On examination, the nurse notes the client has had a rapid weight gain over six weeks. Which action should the nurse implement next?

• A. Review the client's previous blood pressures in the chart.
• B. Obtain the client's blood pressure.
• C. Observe and time the client's contractions.
• D. Examine the client for pedal edema.

Correct answer: B

Rationale: Swollen hands and rapid weight gain could be signs of preeclampsia, so the next step is to check the client's blood pressure. Elevated blood pressure is a key indicator in assessing for preeclampsia in pregnancy. Reviewing the client's previous blood pressures may provide additional context but obtaining the current blood pressure is crucial for immediate assessment. Observing and timing contractions are not relevant in this scenario as the client is not presenting with signs of active labor. Examining for pedal edema is important in assessing for fluid retention, but obtaining the blood pressure takes precedence in this case due to the potential seriousness of preeclampsia.

5. Which of the following processes happen during mitosis?

• A. Strands of deoxyribonucleic acid (DNA) break apart.
• B. Adenine combines with its appropriate partner, cytosine.
• C. Sperm and ova cells are created.
• D. Twenty-three chromosomes are created.

Correct answer: A

Rationale: The correct process that happens during mitosis is the breaking apart, replication, and division of DNA strands into two new cells, each with the same number of chromosomes as the original cell. Choice B is incorrect because it describes base pairing in DNA, not a process specific to mitosis. Choice C is incorrect as the creation of sperm and ova cells is related to meiosis, not mitosis. Choice D is incorrect because chromosomes are not created during mitosis; they are replicated and divided equally between the daughter cells.

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