Nursing Elites

1. When obtaining a health history from a client, a nurse in a woman’s health clinic should identify which of the following findings as increasing the client’s risk for developing pelvic inflammatory disease (PID)?

• A. Recurrent Cystitis
• B. Frequent Alcohol Use
• C. Use of Oral Contraceptives
• D. Chlamydia Infection

Correct answer: D

Rationale: Chlamydia infection is a significant risk factor for developing pelvic inflammatory disease (PID). PID is often caused by untreated sexually transmitted infections (STIs) like Chlamydia and Gonorrhea that ascend from the vagina to the upper reproductive organs. Recurrent cystitis (choice A) is more related to urinary tract infections, frequent alcohol use (choice B) is not directly linked to PID, and the use of oral contraceptives (choice C) does not increase the risk of developing PID.

2. A client is in the second stage of labor. Which of the following manifestations should the nurse expect?

• A. The client expels the placenta
• B. The client experiences gradual dilation of the cervix
• C. The client begins having regular contractions
• D. The client delivers the newborn

Correct answer: D

Rationale: During the second stage of labor, the cervix is fully dilated, and the client delivers the newborn. The expulsion of the placenta occurs during the third stage of labor, not the second stage. Regular contractions typically begin in the first stage of labor, not the second. Gradual dilation of the cervix occurs during the first stage of labor, specifically during the active phase.

3. A client at 34 weeks gestation comes to the birthing center complaining of vaginal bleeding that began one hour ago. The nurse's assessment reveals approximately 30ML of bright red vaginal bleeding, fetal heart rate of 130 - 140 beats per minute, no contractions, and no complaints of pain. What is the most likely cause of this client's bleeding?

• A. Abruptio Placenta
• B. Placenta Previa
• C. Normal bloody show indicating induction of labor
• D. A ruptured blood vessel in the vaginal vault

Correct answer: B

Rationale: Placenta previa, a condition where the placenta covers the cervix, can cause painless, bright red vaginal bleeding in the third trimester. In this scenario, the absence of contractions and pain, along with the presence of significant bright red bleeding, is more indicative of placenta previa rather than abruptio placenta or a ruptured vessel. A normal bloody show typically occurs closer to the onset of labor and is not associated with the amount of bleeding described in the question.

4. A client at 26 weeks gestation was informed this morning that she has an elevated alpha-fetoprotein (AFP) level. After the healthcare provider leaves the room, the client asks what she should do next. What information should the nurse provide?

• A. Reassure the client that the AFP results are likely to be a false reading.
• B. Explain that a sonogram should be scheduled for definitive results.
• C. Inform her that a repeat alpha-fetoprotein (AFP) test should be evaluated.
• D. Discuss options for intrauterine surgical correction of congenital defects.

Correct answer: B

Rationale: An elevated AFP level during pregnancy can indicate potential fetal anomalies. Further evaluation is necessary to confirm the findings and assess the need for additional interventions. Scheduling a sonogram is the appropriate next step as it can provide more definitive results and help identify any underlying issues. Choice A is incorrect because dismissing the elevated AFP level as a false reading without further investigation can lead to missing important information about the baby's health. Choice C is not the best immediate action, as scheduling a sonogram would provide more detailed information than just repeating the AFP test. Choice D is incorrect as discussing intrauterine surgical correction is premature at this stage and not typically indicated based solely on an elevated AFP level.

5. A nurse is teaching about clomiphene citrate to a client who is experiencing infertility. Which of the following adverse effects should the nurse include?

• A. Tinnitus
• B. Urinary Frequency
• C. Breast Tenderness
• D. Chills

Correct answer: C

Rationale: The correct answer is C: 'Breast Tenderness.' Clomiphene citrate is known to cause breast tenderness as a common side effect due to its hormonal effects on the body. Tinnitus (choice A), which is a ringing in the ears, is not typically associated with clomiphene citrate. Urinary frequency (choice B) is not a common adverse effect of this medication. Chills (choice D) are also not commonly linked to clomiphene citrate use.

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