Nursing Elites

1. A client who is at 8 weeks of gestation tells the nurse, 'I am not sure I am happy about being pregnant.' Which of the following responses should the nurse make?

• A. I will inform the provider that you are having these feelings.
• B. It is normal to have these feelings during the first few months of pregnancy.
• C. You should be happy that you are going to bring new life into the world.
• D. I am going to make an appointment with the counselor for you to discuss these thoughts.

Correct answer: B

Rationale: During the first few months of pregnancy, it is common for individuals to experience mixed feelings due to hormonal changes and the significant life adjustments that come with pregnancy. The nurse's response should acknowledge the client's feelings as normal and provide reassurance rather than dismissive or directive statements. By acknowledging the normalcy of these emotions, the nurse validates the client's experience and offers support during this critical time. Choices A, C, and D are less appropriate. Choice A focuses on informing the provider without addressing the client's emotions directly. Choice C disregards the client's current feelings and imposes a specific emotional response. Choice D jumps to scheduling a counseling appointment without first acknowledging the client's emotions or providing immediate support and validation.

2. A client at 32 weeks of gestation with placenta previa is actively bleeding. Which medication should the provider likely prescribe?

• A. Betamethasone
• B. Indomethacin
• C. Nifedipine
• D. Methylergonovine

Correct answer: A

Rationale: In cases of placenta previa with active bleeding at 32 weeks of gestation, Betamethasone is prescribed to accelerate fetal lung maturity in anticipation of potential preterm delivery. This medication helps in reducing the risk of respiratory distress syndrome in the newborn, which is crucial in managing such high-risk pregnancies. Indomethacin is a nonsteroidal anti-inflammatory drug not indicated in this scenario and may be contraindicated due to its effects on platelet function and potential risk of bleeding. Nifedipine is a calcium channel blocker used for conditions like preterm labor or hypertension, not specifically for placenta previa with active bleeding. Methylergonovine is a uterotonic drug used to prevent or control postpartum hemorrhage, not indicated for placenta previa with active bleeding.

3. A charge nurse on the postpartum unit is observing a newly licensed nurse who is preparing to administer pain medication to a client. The charge nurse should intervene when the newly licensed nurse uses which of the following secondary identifiers to identify the client?

• A. The client's room number
• B. The client's telephone number
• C. The client's birth date
• D. The client's medical record number

Correct answer: A

Rationale: The correct answer is A. Using the client's room number as a secondary identifier is not an appropriate method for client identification in healthcare settings. It can lead to confusion and potential errors, especially in a busy environment like a postpartum unit. Room numbers are not unique to individual patients and can change frequently. Instead, healthcare providers should use more reliable and specific identifiers like the client's name, medical record number, or date of birth to ensure accurate identification and safe administration of medications. Choices B, C, and D are more appropriate secondary identifiers for client identification as they are more specific and less prone to errors than room numbers.

4. While observing the electronic fetal heart rate monitor tracing for a client at 40 weeks of gestation in labor, a nurse should suspect a problem with the umbilical cord when she observes which of the following patterns?

• A. Early decelerations
• B. Accelerations
• C. Late decelerations
• D. Variable decelerations

Correct answer: D

Rationale: Variable decelerations can indicate umbilical cord compression, which is a concern that may arise due to the umbilical cord being compressed during labor. This compression can lead to reduced blood flow and oxygen delivery to the fetus, necessitating close monitoring and potentially interventions to alleviate the pressure on the cord. Early decelerations are typically benign and mirror the contractions, indicating fetal head compression. Accelerations are reassuring patterns that show a healthy response to fetal movement. Late decelerations are concerning as they suggest uteroplacental insufficiency, indicating potential oxygen deprivation to the fetus.

5. A healthcare provider is assessing a newborn who has a coarctation of the aorta. Which of the following should the provider recognize as a clinical manifestation of coarctation of the aorta?

• A. Increased blood pressure in the arms with decreased blood pressure in the legs
• B. Decreased blood pressure in the arms with increased blood pressure in the legs
• C. Increased blood pressure in both the arms and the legs
• D. Decreased blood pressure in both the arms and the legs

Correct answer: A

Rationale: The correct answer is increased blood pressure in the arms with decreased blood pressure in the legs. Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities due to decreased blood flow beyond the narrowing. Choice B is incorrect because coarctation of the aorta does not lead to increased blood pressure in the legs. Choice C is incorrect because increased blood pressure in both the arms and legs is not a typical manifestation of coarctation of the aorta. Choice D is incorrect because decreased blood pressure in both the arms and legs is not characteristic of coarctation of the aorta.

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