Nursing Elites

1. A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea, vomiting, and scant, prune-colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect?

• A. Hyperemesis gravidarum
• B. Threatened abortion
• C. Hydatidiform mole
• D. Preterm labor

Correct answer: C

Rationale: In this scenario, the symptoms of continued nausea, vomiting, scant prune-colored discharge, and a fundal height larger than expected at 4 months of gestation suggest a possible hydatidiform mole. Hyperemesis gravidarum (choice A) typically presents with severe nausea, vomiting, weight loss, and electrolyte imbalances. Threatened abortion (choice B) is characterized by vaginal bleeding with or without cramping but does not typically present with prune-colored discharge. Preterm labor (choice D) manifests with regular uterine contractions leading to cervical changes and can occur later in pregnancy.

2. A client who is 2 days postpartum reports that their 4-year-old son, who was previously toilet trained, is now wetting himself frequently. Which of the following statements should the nurse provide to the client?

• A. Your son may not have been ready for toilet training and should wear training pants.
• B. Your son is displaying an adverse sibling response.
• C. Your son may benefit from counseling.
• D. Consider enrolling your son in preschool to address the behavior.

Correct answer: B

Rationale: The regression in toilet training is a common adverse sibling response to the birth of a new baby. When a new sibling arrives, the older child may revert to behaviors from an earlier stage, such as bedwetting, to gain attention or cope with feelings of insecurity. This behavior is temporary and often resolves with time and reassurance. Recommending counseling or preschool at this point would be premature and not addressing the underlying cause of the behavior.

3. When reviewing postpartum nutrition needs with breastfeeding clients, which statement indicates an understanding of the teaching?

• A. I am glad I can have my morning coffee.
• B. I should take folic acid to increase my milk supply.
• C. I will continue adding 330 calories per day to my diet.
• D. I will continue my calcium supplements because I don't like milk.

Correct answer: D

Rationale: The correct answer is D. Clients who do not like milk should continue taking calcium supplements to ensure they meet their increased calcium needs while breastfeeding. Calcium is essential for bone health, and during breastfeeding, the mother's calcium requirements are higher. While caffeine in coffee can be consumed in moderation, folic acid does not directly impact milk supply, and the additional 330 calories per day are recommended but not the focus of this question.

4. A client in active labor is being prepared for epidural analgesia. Which of the following actions should the nurse take?

• A. Have the client sit upright on the bed with legs crossed.
• B. Administer a 500 mL bolus of lactated Ringer's solution prior to induction.
• C. Inform the client that the anesthetic effect will last for approximately 2 hours.
• D. Obtain a 30-minute electronic fetal monitoring (EFM) strip prior to induction.

Correct answer: D

Rationale: Obtaining a 30-minute electronic fetal monitoring (EFM) strip prior to epidural analgesia is crucial to establish a baseline for fetal heart rate and uterine activity. This baseline helps in monitoring fetal well-being during labor and assessing the effect of analgesia on the baby. It enables the healthcare team to identify any changes in the fetal heart rate pattern and uterine contractions, ensuring the safety of both the mother and the baby. Choices A, B, and C are incorrect because having the client sit upright with legs crossed is not necessary for epidural placement, administering a bolus of lactated Ringer's solution is not typically done before epidural analgesia, and the duration of the anesthetic effect varies and is not accurately 2 hours.

5. During newborn gestational age assessment, which finding should be recorded as part of this assessment on the newborn?

• A. Acrocyanosis of hands and feet
• B. Anterior fontanel soft and level
• C. Plantar creases cover 2/3 of sole
• D. Vernix caseosa in inguinal creases

Correct answer: C

Rationale: Plantar creases covering 2/3 of the sole is an important physical characteristic used to assess gestational age in a newborn. This finding is significant because as gestational age advances, the plantar creases cover a larger portion of the sole. It is a valuable clue to the healthcare provider in determining the newborn's maturity level. Choices A, B, and D are incorrect as they do not specifically relate to gestational age assessment. Acrocyanosis and vernix caseosa are common findings in newborns but are not directly used for determining gestational age. The softness and level of the anterior fontanel can provide information about intracranial pressure but are not directly related to gestational age assessment.

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