Nursing Elites

1. A healthcare provider is assisting with the care for a client who has a prescription for magnesium sulfate. The provider should recognize that which of the following are contraindications for the use of this medication? (Select all that apply)

• A. Fetal distress
• B. Cervical dilation greater than 6 cm
• C. Vaginal bleeding
• D. All of the Above

Correct answer: D

Rationale: The correct answer is D, 'All of the Above.' Magnesium sulfate should not be used in cases of fetal distress, vaginal bleeding, or cervical dilation greater than 6 cm. These conditions can be exacerbated by the administration of magnesium sulfate, leading to further complications for the client. Choice A, fetal distress, is a contraindication because magnesium sulfate can further affect the fetal heart rate. Choice B, cervical dilation greater than 6 cm, is a contraindication as magnesium sulfate can potentially suppress uterine contractions, prolonging labor. Choice C, vaginal bleeding, is a contraindication as magnesium sulfate can further increase bleeding tendencies.

2. A client in labor requests epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care?

• A. Position the client supine for 30 minutes after the first dose of anesthetic solution.
• B. Administer 1,000 mL of dextrose 5% in water after the first dose of anesthetic solution.
• C. Monitor the client's blood pressure every 5 minutes after the first dose of anesthetic solution.
• D. Ensure the client has been NPO for 4 hours before the placement of the epidural and the first dose of anesthetic solution.

Correct answer: C

Rationale: The correct action is to monitor the client's blood pressure every 5 to 10 minutes following the first dose of anesthetic solution to assess for maternal hypotension. This is crucial to detect and manage potential complications associated with the epidural anesthesia. Positioning the client supine for a prolonged period can lead to hypotension; administering dextrose solution is not a standard practice in epidural anesthesia; ensuring NPO status for 4 hours is not necessary before epidural placement.

3. A client at 36 weeks of gestation is suspected of having placenta previa. Which of the following findings support this diagnosis?

• A. Painless red vaginal bleeding
• B. Increasing abdominal pain with a non-relaxed uterus
• C. Abdominal pain with scant red vaginal bleeding
• D. Intermittent abdominal pain following the passage of bloody mucus

Correct answer: A

Rationale: Painless red vaginal bleeding is a hallmark sign of placenta previa. In this condition, the placenta partially or completely covers the cervical opening, leading to painless, bright red bleeding due to the separation of the placenta from the uterine wall. Other types of bleeding, such as those associated with abdominal pain or mucus passage, are more indicative of conditions like placental abruption rather than placenta previa. Therefore, choices B, C, and D are incorrect as they describe findings more consistent with placental abruption rather than placenta previa.

4. A client is in labor, and a nurse observes late decelerations on the electronic fetal monitor. What should the nurse identify as the first action that the registered nurse should take?

• A. Assist the client into the left-lateral position
• B. Apply a fetal scalp electrode
• C. Insert an IV catheter
• D. Perform a vaginal exam

Correct answer: A

Rationale: Late decelerations indicate uteroplacental insufficiency. The initial action should be to assist the client into the left-lateral position to optimize maternal blood flow and oxygenation to the fetus, thereby improving uteroplacental blood flow and fetal oxygenation. This position helps reduce pressure on the vena cava, enhancing blood return to the heart and improving circulation to the placenta. Applying a fetal scalp electrode (Choice B) is not the first action indicated for late decelerations. Inserting an IV catheter (Choice C) and performing a vaginal exam (Choice D) are not primary interventions for addressing late decelerations related to uteroplacental insufficiency.

5. A healthcare provider is assisting with the care for a client who reports manifestations of preterm labor. Which of the following findings are risk factors for this condition? (Select all that apply)

• A. Urinary tract infection
• B. Multifetal pregnancy
• C. Oligohydramnios
• D. All of the Above

Correct answer: D

Rationale: The correct answer is D: All of the Above. Multiple risk factors can contribute to preterm labor, including urinary tract infection, multifetal pregnancy, and oligohydramnios. These factors can lead to the uterus being irritated or overstimulated, potentially triggering early labor. Urinary tract infections can cause inflammation and contractions, multifetal pregnancies have a higher risk of preterm labor due to increased uterine stretching, and oligohydramnios can lead to poor fetal growth and premature contractions. Therefore, clients presenting with these conditions require close monitoring and management to prevent preterm birth. Choices A, B, and C are all correct risk factors for preterm labor, making option D the correct answer.

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