Nursing Elites

1. A healthcare provider in the emergency department is caring for a client who comes to the emergency department reporting severe abdominal pain in the left lower quadrant. The provider suspects a ruptured ectopic pregnancy. Which of the following signs indicates to the provider the presence of intra-abdominal bleeding?

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

Correct answer: B

Rationale: Cullen's sign is the presence of periumbilical ecchymosis indicating intra-abdominal bleeding, which can be associated with a ruptured ectopic pregnancy. Chvostek's sign is a facial spasm related to hypocalcemia. Chadwick's sign is a bluish discoloration of the cervix, vagina, and labia during early pregnancy. Goodell's sign is a softening of the cervix in early pregnancy.

2. A client at 37 weeks of gestation with severe gestational hypertension is being admitted by a nurse. Which of the following actions should the nurse NOT expect to implement?

• A. Administer magnesium sulfate IV.
• B. Provide a dark, quiet environment.
• C. Assess respiratory status every 4 hours.
• D. Ensure that calcium gluconate is readily available.

Correct answer: C

Rationale: Assessing respiratory status every 4 hours is not a priority for a client with severe gestational hypertension. In this scenario, the focus should be on monitoring blood pressure, assessing for signs of preeclampsia, administering medications like magnesium sulfate for seizure prophylaxis, and ensuring that calcium gluconate is readily available in case of magnesium toxicity. Respiratory status assessment is important in other conditions but is not directly related to managing severe gestational hypertension.

3. A client in labor at 40 weeks of gestation has saturated two perineal pads in the past 30 min. The nurse suspects placenta previa. Which of the following is an appropriate nursing action?

• A. Examination to determine cervical status
• B. A magnesium sulfate infusion
• C. Initiation of pushing
• D. Preparation for cesarean birth

Correct answer: D

Rationale: In the scenario described, the client is experiencing heavy vaginal bleeding, which is concerning for placenta previa. The appropriate nursing action in this situation is to prepare for a cesarean birth. Placenta previa is a condition where the placenta partially or completely covers the cervix, which can lead to life-threatening bleeding during labor. It is crucial to avoid vaginal examinations or initiation of pushing as these actions can exacerbate bleeding. A magnesium sulfate infusion is not indicated in the management of placenta previa. Therefore, the priority intervention is to prepare for a cesarean birth to ensure the safety of the mother and the baby.

4. A client with preterm labor is being admitted. The nurse anticipates a prescription by the provider for which of the following medications?

• A. Prostaglandin E2
• B. Indomethacin
• C. Methylergonovine
• D. Oxytocin

Correct answer: B

Rationale: Indomethacin is used to delay premature labor by inhibiting uterine contractions. Prostaglandin E2, Methylergonovine, and Oxytocin are not typically used to manage preterm labor. Prostaglandin E2 can be used for cervical ripening and labor induction. Methylergonovine is used to prevent or control postpartum hemorrhage. Oxytocin is used for labor induction and augmentation of labor in term pregnancies.

5. A client who experienced a cesarean birth due to dysfunctional labor expresses disappointment for not having a natural childbirth. Which response should the nurse make?

• A. Validate the client's feelings by saying, 'It sounds like you are feeling sad that things didn't go as planned.'
• B. Assure the client by stating, 'At least you know you have a healthy baby.'
• C. Encourage the client by suggesting, 'Maybe next time you can have a vaginal delivery.'
• D. Provide information by saying, 'You can resume sexual relations sooner than if you had delivered vaginally.'

Correct answer: A

Rationale: The correct response is to acknowledge and validate the client's feelings of disappointment. This empathetic approach demonstrates understanding and support for the client's emotional state, fostering a therapeutic nurse-client relationship. Options B, C, and D do not address the client's emotional needs or provide appropriate support in this situation.

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