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 at 6 weeks of gestation with her first pregnancy asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make?

• A. This will occur during the last trimester of pregnancy.
• B. This will happen by the end of the first trimester of pregnancy.
• C. This will occur between the fourth and fifth months of pregnancy.
• D. This will happen once the uterus begins to rise out of the pelvis.

Correct answer: C

Rationale: Quickening, which is the first perception of fetal movements by the mother, typically occurs between the fourth and fifth months of pregnancy, around 18-20 weeks of gestation. Choice C is correct as it provides the client with accurate information about the expected timing of this significant milestone in her pregnancy. Choices A, B, and D are incorrect because quickening does not happen during the last trimester, by the end of the first trimester, or once the uterus begins to rise out of the pelvis. The correct timeframe for quickening is during the second trimester, specifically between the fourth and fifth months.

3. A healthcare provider is instructing a client who is taking an oral contraceptive about manifestations to report. Which of the following manifestations should the healthcare provider include?

• A. Reduced menstrual flow
• B. Breast tenderness
• C. Shortness of breath
• D. Increased appetite

Correct answer: C

Rationale: Shortness of breath is a symptom that can indicate a serious side effect of oral contraceptives, such as a potential blood clot in the lungs. This condition requires immediate medical attention to prevent complications. Choices A, B, and D are not typically associated with serious side effects of oral contraceptives and are considered normal or common side effects that do not require urgent medical attention.

4. A client is scheduled for a cesarean birth based on fetal lung maturity. Which finding indicates that the fetal lungs are mature?

• A. Absence of Phosphatidylglycerol (PG)
• B. Biophysical profile score of 8
• C. Lecithin/sphingomyelin (L/S) ratio of 2:1
• D. Reactive nonstress test

Correct answer: C

Rationale: An L/S ratio of 2:1 indicates fetal lung maturity, as it signifies the presence of surfactant in the amniotic fluid, which helps with lung expansion and prevents collapse at the end of expiration. The absence of PG indicates immaturity of the fetal lungs, as PG appears in the amniotic fluid during the later stages of lung maturation. Biophysical profile scores and nonstress tests are assessments of fetal well-being and do not directly indicate fetal lung maturity. Therefore, choice C is the correct answer.

5. When checking for the Moro reflex in a newborn, what action should the nurse take?

• A. Hold the newborn vertically under arms and allow one foot to touch the table.
• B. Stimulate the pads of the newborn's hands with stroking or massage.
• C. Stimulate the soles of the newborn's feet on the outer lateral surface of each foot.
• D. Hold the newborn in a semi-sitting position, then allow the newborn's head and trunk to fall backward.

Correct answer: D

Rationale: The correct action to check for the Moro reflex in a newborn is to hold the newborn in a semi-sitting position and then allow the newborn's head and trunk to fall backward. The Moro reflex is elicited by a sudden loss of support or a loud noise. The normal response involves symmetrical abduction and extension of the arms, followed by their return to the midline in an embracing motion. Choices A, B, and C do not describe the correct method for assessing the Moro reflex and are therefore incorrect.

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