Nursing Elites

1. A healthcare provider is assessing a newborn who has a coarctation of the aorta. Which of the following should the provider recognize as a clinical manifestation of coarctation of the aorta?

• A. Increased blood pressure in the arms with decreased blood pressure in the legs
• B. Decreased blood pressure in the arms with increased blood pressure in the legs
• C. Increased blood pressure in both the arms and the legs
• D. Decreased blood pressure in both the arms and the legs

Correct answer: A

Rationale: The correct answer is increased blood pressure in the arms with decreased blood pressure in the legs. Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities due to decreased blood flow beyond the narrowing. Choice B is incorrect because coarctation of the aorta does not lead to increased blood pressure in the legs. Choice C is incorrect because increased blood pressure in both the arms and legs is not a typical manifestation of coarctation of the aorta. Choice D is incorrect because decreased blood pressure in both the arms and legs is not characteristic of coarctation of the aorta.

2. A client in the antepartum unit is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

• A. Placenta previa
• B. Prolapsed cord
• C. Incompetent cervix
• D. Abruptio placentae

Correct answer: D

Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall, which can cause continuous abdominal pain and vaginal bleeding. In this scenario, the client's symptoms of sudden abdominal pain and vaginal bleeding are indicative of abruptio placentae, which requires immediate medical attention to prevent potential complications for both the client and the fetus. Placenta previa is characterized by painless vaginal bleeding in the third trimester, not sudden abdominal pain. Prolapsed cord presents with visible umbilical cord protruding from the vagina and is not associated with abruptio placentae symptoms. Incompetent cervix typically manifests as painless cervical dilation in the second trimester, not sudden abdominal pain and bleeding as seen in abruptio placentae.

3. A nurse in a health clinic is reinforcing teaching about contraceptive use with a group of clients. Which of the following client statements demonstrates understanding?

• A. Using a water-soluble lubricant with condoms can help prevent breakage and ensure effectiveness in preventing pregnancy and STIs.
• B. A diaphragm should be removed 2 hours after intercourse.
• C. Oral contraceptives can worsen a case of acne.
• D. A contraceptive patch is replaced once a month.

Correct answer: A

Rationale: The correct answer is A because using a water-soluble lubricant with condoms can help prevent breakage and ensure effectiveness in preventing pregnancy and sexually transmitted infections (STIs). This statement demonstrates the client's understanding of the importance of proper condom use to maximize protection. Choice B is incorrect because a diaphragm should be left in place for at least 6 hours after intercourse to ensure contraceptive effectiveness. Choice C is incorrect as oral contraceptives are known to improve acne in some cases. Choice D is incorrect because a contraceptive patch is typically replaced weekly, not monthly.

4. When reinforcing discharge teaching to the parents of a newborn regarding circumcision care, which statement made by a parent indicates an understanding of the teaching?

• A. The circumcision will heal within a couple of days.
• B. I should not remove the yellow mucus that will form.
• C. I will clean the penis with each diaper change.
• D. I will give him a tub bath within a couple of days.

Correct answer: C

Rationale: The correct answer is C because cleaning the penis with each diaper change is essential for preventing infection and promoting healing after circumcision. This practice helps maintain good hygiene and reduces the risk of complications. Removing the yellow mucus or giving a tub bath too soon can interfere with the healing process and increase the likelihood of infection. Choice A is incorrect because circumcision healing usually takes about a week or more, not just a couple of days. Choice B is incorrect because parents should gently clean the area, including removing any discharge or debris as part of proper care. Choice D is incorrect because tub baths should be avoided until the circumcision is fully healed to prevent infection.

5. When a client states, 'My water just broke,' what is the nurse's priority intervention?

• A. Perform Nitrazine testing.
• B. Assess the fluid.
• C. Check cervical dilation.
• D. Begin FHR monitoring.

Correct answer: D

Rationale: The correct answer is D: Begin FHR monitoring. The priority intervention when a client's water breaks is to assess the fetal well-being due to the risk of umbilical cord prolapse. Monitoring the fetal heart rate (FHR) will help the nurse ensure the fetus's well-being. Performing Nitrazine testing (choice A) or assessing the fluid (choice B) may provide information about the rupture of membranes but does not directly address fetal well-being. Checking cervical dilation (choice C) is important but not the priority when the client's water has broken.

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