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 healthcare provider is assisting with the care of a newborn immediately following birth. Which of the following nursing interventions is the highest priority?

• A. Initiating breastfeeding
• B. Performing the initial bath
• C. Giving a vitamin K injection
• D. Covering the newborn's head with a cap

Correct answer: D

Rationale: Covering the newborn's head with a cap is the highest priority immediately following birth to prevent heat loss. Newborns are at risk of hypothermia due to their immature thermoregulation, making it crucial to maintain their body temperature. By covering the newborn's head with a cap, heat loss through the head is minimized, helping to keep the baby warm and stable in the immediate post-birth period. Initiating breastfeeding, performing the initial bath, and giving a vitamin K injection are important interventions but are not as high a priority as ensuring the newborn's thermal stability.

3. A client with a BMI of 26.5 is seeking advice on weight gain during pregnancy at the first prenatal visit. Which of the following responses should the nurse provide?

• A. It would be best if you gained about 11 to 20 pounds.
• B. The recommendation for you is about 15 to 25 pounds.
• C. A gain of about 25 to 35 pounds is recommended for you.
• D. A gain of about 1 pound per week is the best pattern for you.

Correct answer: B

Rationale: For a client with a BMI of 26.5 (overweight), the recommended weight gain during pregnancy is 15 to 25 pounds. This range helps promote a healthy pregnancy outcome and reduces the risk of complications associated with excessive weight gain. Option A suggests a lower weight gain range, which may not be adequate for a client with a BMI of 26.5. Option C indicates a higher weight gain range, which could lead to complications for an overweight individual. Option D provides a general guideline for weight gain without considering the client's BMI, which is not personalized advice. Therefore, the most appropriate response is option B, offering a suitable weight gain recommendation for the client's BMI to support a healthy pregnancy journey.

4. During the third trimester of pregnancy, which of the following findings should a nurse recognize as an expected physiologic change?

• A. Gradual lordosis
• B. Increased abdominal muscle tone
• C. Posterior neck flexion
• D. Decreased mobility of pelvic joints

Correct answer: A

Rationale: During pregnancy, gradual lordosis is a common adaptation to the growing fetus. Lordosis refers to an increased lumbar curve in the spine, which helps to shift the center of gravity forward, supporting the enlarging uterus. This change is necessary to maintain balance and reduce strain on the back muscles as the pregnancy progresses. Increased abdominal muscle tone, posterior neck flexion, and decreased mobility of pelvic joints are not typical physiological changes during pregnancy. Increased abdominal muscle tone is not expected as the abdominal muscles tend to stretch and separate to accommodate the growing fetus. Posterior neck flexion is not a common finding and decreased mobility of pelvic joints is not an expected change and can cause discomfort.

5. A client in a family planning clinic requests oral contraceptives. Which of the following findings in the client's history should be recognized as contraindications to oral contraceptives? (Select all that apply.)

• A. Cholecystitis
• B. Hypertension
• C. Migraine headaches
• D. All of the above

Correct answer: D

Rationale: Cholecystitis is a correct answer. A history of gallbladder disease, such as cholecystitis, is a contraindication for the use of oral contraceptives. Hypertension is a correct answer. Hypertension is also a contraindication for the use of oral contraceptives due to the increased risk of complications. Migraine headaches are a correct answer. A history of migraine headaches is a contraindication for the use of oral contraceptives, especially for those with aura. Selecting 'All of the above' is correct as all the mentioned conditions (cholecystitis, hypertension, and migraine headaches) are contraindications for oral contraceptives. Human papillomavirus and anxiety disorder are incorrect choices as they are not contraindications for the use of oral contraceptives.

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