Nursing Elites

1. A female client is seen in the clinic for a gynecological examination. The nurse begins collecting subjective data. Which topic does the nurse ask the client about first?

• A. Her sexual history
• B. Her menstrual history
• C. Her obstetrical history
• D. The presence of vaginal drainage

Correct answer: B

Rationale: The nurse should begin by asking the client about her menstrual history as it is usually nonthreatening. This information can provide insights into the client's reproductive health and any irregularities. Menstrual history is a common starting point for gynecological assessments and can help in understanding the client's overall health status. Asking about sexual history may be more sensitive and personal, not always appropriate to start with. Obstetrical history pertains to pregnancies and may not be relevant if the client has not been pregnant. Inquiring about the presence of vaginal drainage is important but is usually addressed after gathering more general information about the client's health.

2. A male client is learning about testicular self-examination (TSE) from a nurse. Which statement should the nurse make to the client?

• A. 'A good time to examine the testicles is during or after you take a shower.'
• B. 'If you notice an enlarged testicle or a lump, you need to notify the physician.'
• C. 'The testicle is round and smooth. It feels firm and without lumps.'
• D. 'Perform a testicular exam monthly to detect early signs of testicular cancer.'

Correct answer: B

Rationale: The correct statement for the nurse to make to the client is 'If you notice an enlarged testicle or a lump, you need to notify the physician.' During a shower or bath is the best time to examine the testes because warm temperatures make the testes hang lower in the scrotum. The testes should feel round and smooth, without lumps. Self-examination should be performed monthly to detect any abnormalities early. The physician needs to be notified immediately if any abnormal findings are noticed. Choice A is incorrect because the best time for TSE is during or after a warm shower or bath, not just before. Choice C is incorrect as the testicle should feel round, smooth, and without lumps, not egg-shaped and lumpy. Choice D is incorrect as monthly self-examinations are recommended, not every 2 months.

3. Which of the following statements, if made by the parents of a newborn, does not indicate a need for further teaching about cord care?

• A. "I should put alcohol on my baby's cord 3-4 times a day."?
• B. "I should put the baby's diaper on so that it covers the cord."?
• C. "I should call the physician if the cord becomes dark."?
• D. "I should wash my hands before and after I take care of the cord."?

Correct answer: A

Rationale: Explanation: Parents should be taught that putting alcohol or other antimicrobials on the cord is no longer recommended for cord care. This can interfere with the natural healing process and may increase the risk of irritation or infection. Washing hands before and after providing cord care is essential to prevent the transfer of pathogens. Placing the baby's diaper below the cord allows it to be exposed to air and promotes drying, reducing the risk of infection. It is normal for the cord to turn dark as it dries, so calling the physician only if the cord becomes red, swollen, or has discharge is appropriate. Therefore, the statement '"I should put alcohol on my baby's cord 3-4 times a day."?' indicates a need for further teaching about cord care.

4. The client has an order for a 1,000 mL bag of fluids to be infused over 8 hours. What is the correct rate?

• A. 100 mL/hr
• B. 125 mL/min
• C. 125 mL/hr
• D. 80 mL/min

Correct answer: C

Rationale: To determine the correct infusion rate, divide the total volume of fluids (1,000 mL) by the total infusion time (8 hours), resulting in a rate of 125 mL/hr. This calculation ensures the appropriate administration of fluids over the specified time period. Choice A (100 mL/hr) is incorrect as it does not match the calculated rate based on the given information. Choice B (125 mL/min) is inaccurate because the question specifies the rate in hours, not minutes. Choice D (80 mL/min) is incorrect as it provides the rate in minutes rather than hours, which is the required unit for this scenario.

5. A nurse is explaining a nonstress test to a pregnant client. The nurse explains that the results are nonreactive if which finding is noted on the electronic monitoring recording strip?

• A. Two fetal heart accelerations within a 20-minute period, peaking at 15 beats/min above baseline and lasting 15 seconds from baseline to baseline
• B. Accelerations without fetal movement with fetal heart rate (FHR) increases of 15 beats/min for 15 seconds
• C. Acceleration of the FHR by 25 to 30 beats/min for at least 15 seconds in response to fetal movement
• D. Absence of accelerations after fetal movement

Correct answer: D

Rationale: The correct answer is 'Absence of accelerations after fetal movement.' In a nonreactive (nonreassuring) stress test, the monitor recording would not show accelerations after fetal movement within a 40-minute period. This absence of accelerations indicates a nonreactive result. Choices A, B, and C describe different patterns of fetal heart rate accelerations that are not indicative of a nonreactive result in a nonstress test, making them incorrect. Choice A describes the characteristics of a reactive (reassuring) result, where there should be at least two fetal heart accelerations within a 20-minute period, peaking at least 15 beats/min above the baseline, and lasting 15 seconds from baseline to baseline. Choice B incorrectly states 'Accelerations without fetal movement,' which is contradictory. Choice C describes an acceleration response to fetal movement, which does not signify a nonreactive result.

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