Nursing Elites

1. A client who is 2 days postpartum reports that their 4-year-old son, who was previously toilet trained, is now wetting himself frequently. Which of the following statements should the nurse provide to the client?

• A. Your son may not have been ready for toilet training and should wear training pants.
• B. Your son is displaying an adverse sibling response.
• C. Your son may benefit from counseling.
• D. Consider enrolling your son in preschool to address the behavior.

Correct answer: B

Rationale: The regression in toilet training is a common adverse sibling response to the birth of a new baby. When a new sibling arrives, the older child may revert to behaviors from an earlier stage, such as bedwetting, to gain attention or cope with feelings of insecurity. This behavior is temporary and often resolves with time and reassurance. Recommending counseling or preschool at this point would be premature and not addressing the underlying cause of the behavior.

2. A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, 'I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device.' The nurse should suspect which of the following?

• A. Missed abortion
• B. Ectopic pregnancy
• C. Severe preeclampsia
• D. Hydatidiform mole

Correct answer: B

Rationale: Ectopic pregnancy should be suspected in clients with abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding, especially if they have an intrauterine device (IUD). In this case, the client's symptoms are classic for ectopic pregnancy, where the fertilized egg implants outside the uterus, commonly in the fallopian tube. Missed abortion (choice A) refers to a nonviable embryo or fetus in the uterus, which is not consistent with the client's presentation. Severe preeclampsia (choice C) is characterized by hypertension and proteinuria, not the symptoms described. Hydatidiform mole (choice D) presents with vaginal bleeding but typically lacks abdominal pain and is not related to the presence of an IUD.

3. A client in labor is having contractions 4 minutes apart. Which of the following patterns should the nurse expect on the fetal monitoring tracing?

• A. Contractions that last for 60 seconds each with a 4-minute rest between contractions
• B. A contraction that lasts 4 minutes followed by a period of relaxation
• C. Contractions that last for 60 seconds each with a 3-minute rest between contractions
• D. Contractions that last 45 seconds each with a 3-minute rest between contractions

Correct answer: C

Rationale: The correct answer is C. When contractions are 4 minutes apart, it means there are 4 minutes from the start of one contraction to the start of the next. If each contraction lasts 60 seconds, there will be a 3-minute rest period between contractions. This allows for adequate uterine relaxation and recovery before the next contraction begins. Choice A is incorrect because it suggests a 4-minute rest between contractions, which is not accurate. Choice B is incorrect as contractions lasting 4 minutes continuously without rest would be concerning. Choice D is incorrect as it suggests 45-second contractions instead of 60-second contractions.

4. A newborn is noted to have secretions bubbling out of the nose and mouth after delivery. What is the nurse's priority action?

• A. Suction the nose with a bulb syringe.
• B. Suction the mouth with a bulb syringe.
• C. Use a suction catheter with low negative pressure.
• D. Turn the newborn on their side.

Correct answer: B

Rationale: The priority action for the nurse is to suction the mouth with a bulb syringe. Suctioning the mouth first is crucial to prevent aspiration and ensure the airway is clear, which takes precedence over suctioning the nose. This intervention helps maintain a patent airway and promotes adequate breathing in the newborn. Using a suction catheter with low negative pressure may not be appropriate as the newborn needs a gentle suction method like a bulb syringe. Turning the newborn on their side is important if there is a risk of aspiration, but clearing the mouth of secretions should be the priority to establish a clear airway.

5. A nurse on the labor and delivery unit is caring for a client who is having a difficult, prolonged labor with severe backache. Which of the following contributing causes should the nurse identify?

• A. Fetal attitude is in general flexion.
• B. Fetal lie is longitudinal.
• C. Maternal pelvis is gynecoid.
• D. Fetal position is persistent occiput posterior.

Correct answer: D

Rationale: The correct answer is D. In a persistent occiput posterior position, the baby's head presses against the mother's spine, causing prolonged labor and severe backache. This position can lead to difficulties in labor progress and increase discomfort for the mother. Choices A, B, and C are incorrect as they do not directly relate to the client's difficult, prolonged labor with severe backache. Fetal attitude, fetal lie, and maternal pelvis type may affect labor, but in this scenario, the persistent occiput posterior fetal position is the primary contributing cause for the client's symptoms.

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