Nursing Elites

1. While assisting with the care of a client in active labor, a nurse observes clear fluid and a loop of pulsating umbilical cord outside the client's vagina. Which of the following actions should the nurse perform first?

• A. Place the client in the Trendelenburg position
• B. Apply finger pressure to the presenting part
• C. Administer oxygen at 10 L/min via a non-rebreather
• D. Call for assistance

Correct answer: D

Rationale: In the scenario of umbilical cord prolapse during labor, the nurse should first call for assistance. Umbilical cord prolapse is a critical obstetric emergency that requires immediate attention and skilled assistance. Calling for help ensures that additional support is on the way to provide prompt intervention. Placing the client in the Trendelenburg position (Choice A) is no longer recommended as it may worsen the situation. Applying finger pressure to the presenting part (Choice B) can further compress the cord. Administering oxygen (Choice C) is important but should come after addressing the prolapsed cord.

2. A healthcare professional is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the professional use to help minimize the pain of the procedure for the newborn?

• A. Apply a cool pack to the heel for 10 minutes prior to the puncture.
• B. Request a prescription for IM analgesic.
• C. Use a manual lancet to pierce the skin.
• D. Place the newborn skin-to-skin on the mother's chest.

Correct answer: D

Rationale: Placing the newborn skin-to-skin on the mother's chest is an effective technique to significantly decrease the newborn's pain level and anxiety during a heel stick procedure. This approach provides comfort, warmth, and familiarity to the newborn, promoting a sense of security and reducing distress. It is important for the healthcare professional to implement this technique before, during, and after the procedure to optimize pain management and support newborn well-being. The other options, such as applying a cool pack, requesting an IM analgesic prescription, and using a manual lancet, are not appropriate for minimizing pain in a newborn during a heel stick procedure. Applying a cool pack may cause vasoconstriction and increase pain, requesting an IM analgesic for a routine heel stick is excessive, and using a manual lancet without additional comforting measures may not adequately address the newborn's pain and anxiety.

3. When providing care for a client in preterm labor at 32 weeks of gestation, which medication should the nurse anticipate the provider will prescribe to hasten fetal lung maturity?

• A. Calcium gluconate
• B. Indomethacin
• C. Nifedipine
• D. Betamethasone

Correct answer: D

Rationale: Betamethasone is the correct medication to anticipate the provider prescribing to hasten fetal lung maturity in clients at risk for preterm labor. It is a corticosteroid that helps promote lung maturation in the preterm fetus by stimulating the production of surfactant, which is essential for lung function. This medication is commonly given to pregnant individuals at risk of preterm delivery between 24 and 34 weeks of gestation to reduce the risk of respiratory distress syndrome in the newborn. Calcium gluconate, Indomethacin, and Nifedipine are not used to hasten fetal lung maturity in preterm labor; they serve different purposes in maternal and fetal care.

4. After an amniotomy, what is the priority nursing action?

• A. Observe color and consistency of fluid
• B. Assess the fetal heart rate pattern
• C. Assess the client's temperature
• D. Evaluate the client for the presence of chills and increased uterine tenderness using palpation

Correct answer: B

Rationale: After an amniotomy, the priority nursing action is to assess the fetal heart rate pattern. This is crucial to monitor for any signs of fetal distress, as changes in the fetal heart rate could indicate potential complications related to the procedure. Observing the color and consistency of the fluid (Choice A) is important but not the priority over assessing fetal well-being. Assessing the client's temperature (Choice C) and evaluating the client for chills and increased uterine tenderness (Choice D) are not immediate priorities following an amniotomy.

5. A nurse is caring for several clients. The nurse should recognize that it is safe to administer tocolytic therapy to which of the following clients?

• A. A client who is experiencing fetal death at 32 weeks of gestation
• B. A client who is experiencing preterm labor at 26 weeks of gestation
• C. A client who is experiencing Braxton-Hicks contractions at 36 weeks of gestation
• D. A client who has a post-term pregnancy at 42 weeks of gestation

Correct answer: B

Rationale: Tocolytic therapy is used to suppress premature labor. It is appropriate to administer it to a client experiencing preterm labor at 26 weeks of gestation to help delay delivery and improve neonatal outcomes. Administering tocolytic therapy to a client experiencing fetal death, Braxton-Hicks contractions, or post-term pregnancy is not indicated and may not be safe or effective in these situations. Fetal death at 32 weeks indicates a non-viable pregnancy, Braxton-Hicks contractions are normal and not indicative of preterm labor, and post-term pregnancy at 42 weeks does not require tocolytic therapy.

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