Nursing Elites

1. A healthcare professional in a provider's office is reviewing the medical record of a client who is in her first trimester of pregnancy. Which of the following findings should the healthcare professional identify as a risk factor for the development of preeclampsia?

• A. Singleton pregnancy
• B. BMI of 20
• C. Maternal age of 32 years
• D. Pregestational diabetes mellitus

Correct answer: D

Rationale: Pregestational diabetes mellitus is a significant risk factor for the development of preeclampsia in pregnant individuals. Preeclampsia is more common in women with preexisting conditions such as diabetes, hypertension, renal disease, lupus, or rheumatoid arthritis. Singleton pregnancy, a BMI of 20, or maternal age of 32 years are not considered significant risk factors for developing preeclampsia.

2. A client who is postpartum has a slightly boggy and displaced fundus to the right. Which of the following actions should the nurse take based on these findings?

• A. Encourage the client to perform Kegel exercises.
• B. Encourage the client to move to the left lateral position.
• C. Ask the client to rate her pain.
• D. Assist the client to the bathroom to void.

Correct answer: D

Rationale: A displaced and boggy fundus in a postpartum client typically indicates a full bladder, which can impede uterine contractions and increase the risk of postpartum hemorrhage. Assisting the client to the bathroom to void helps ensure the bladder is empty, aiding the fundus to contract and reducing the risk of complications. Encouraging Kegel exercises, changing positions, or assessing pain would not directly address the issue of the boggy fundus caused by a full bladder.

3. A parent is receiving discharge teaching from a nurse regarding caring for their newborn after a circumcision. Which instruction should the nurse include?

• A. Apply slight pressure with a sterile gauze pad for mild bleeding.
• B. Inspect the circumcision site every 6 to 8 hours.
• C. Avoid using baby wipes containing alcohol to cleanse the penis with each diaper change.
• D. Clean the circumcision site daily using a warm, wet washcloth.

Correct answer: A

Rationale: The correct answer is to apply slight pressure with a sterile gauze pad for mild bleeding. This helps to stop bleeding. If the bleeding persists, the parent should contact the healthcare provider for further guidance. While inspecting the circumcision site is important, checking every 6 to 8 hours might be too frequent and could disrupt healing. Using baby wipes containing alcohol can irritate the sensitive skin, so it is advised to avoid them. Cleaning the circumcision site daily is crucial, but excessive cleaning by removing yellow exudate daily is not necessary unless advised by the healthcare provider.

4. A healthcare professional in the emergency department is caring for a client who presents with severe abdominal pain in the left lower quadrant. The provider suspects a ruptured ectopic pregnancy. Which of the following signs indicates to the healthcare professional that the client has blood in the peritoneum?

• A. Chvostek's sign
• B. Cullen's sign
• C. Chadwick's sign
• D. Goodell's sign

Correct answer: B

Rationale: Cullen's sign, which presents as bruising around the umbilicus, indicates the presence of blood in the peritoneum. This sign is significant in cases of a ruptured ectopic pregnancy as it suggests intraperitoneal bleeding, prompting immediate medical attention. Chvostek's sign is related to facial muscle spasm and is not indicative of peritoneal bleeding. Chadwick's sign refers to a bluish discoloration of the cervix and vagina during pregnancy, not related to peritoneal bleeding. Goodell's sign is a softening of the cervix, which is a sign of pregnancy, and not specific to peritoneal bleeding.

5. A client is being educated by a healthcare provider about potential adverse effects of implantable progestins. Which of the following adverse effects should the healthcare provider include? (Select all that apply)

• A. Nausea
• B. Irregular vaginal bleeding
• C. Weight gain
• D. All of the Above

Correct answer: D

Rationale: When educating a client about implantable progestins, it is important to discuss potential adverse effects. Nausea, irregular vaginal bleeding, and weight gain are common side effects associated with implantable progestins. Therefore, clients should be informed about these possibilities to ensure they are aware of what to expect and when to seek medical attention if needed. Choice D, 'All of the Above,' is the correct answer because all of the listed adverse effects (nausea, irregular vaginal bleeding, and weight gain) should be included in the client education. Choices A, B, and C are incorrect because they individually do not encompass all the potential adverse effects that the healthcare provider should discuss with the client.

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