Nursing Elites

1. While assisting with the care of an infant with a high bilirubin level receiving phototherapy, which finding should the nurse prioritize for reporting to the charge nurse?

• A. Conjunctivitis
• B. Bronze skin discoloration
• C. Sunken fontanels
• D. Maculopapular skin rash

Correct answer: C

Rationale: Sunken fontanels should be prioritized for reporting as they indicate dehydration, which is a critical concern in infants undergoing phototherapy. Dehydration can lead to serious complications, making it essential for the nurse to promptly inform the charge nurse for appropriate intervention and management. Conjunctivitis, bronze skin discoloration, and maculopapular skin rash are important findings to note, but in this scenario, sunken fontanels take precedence due to the potential severity of dehydration in infants.

2. A healthcare provider is instructing a client who is taking an oral contraceptive about manifestations to report. Which of the following manifestations should the healthcare provider include?

• A. Reduced menstrual flow
• B. Breast tenderness
• C. Shortness of breath
• D. Increased appetite

Correct answer: C

Rationale: Shortness of breath is a symptom that can indicate a serious side effect of oral contraceptives, such as a potential blood clot in the lungs. This condition requires immediate medical attention to prevent complications. Choices A, B, and D are not typically associated with serious side effects of oral contraceptives and are considered normal or common side effects that do not require urgent medical attention.

3. A client who is at 6 weeks of gestation with her first pregnancy asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make?

• A. This will occur during the last trimester of pregnancy.
• B. This will happen by the end of the first trimester of pregnancy.
• C. This will occur between the fourth and fifth months of pregnancy.
• D. This will happen once the uterus begins to rise out of the pelvis.

Correct answer: C

Rationale: Quickening, which is the first perception of fetal movements by the mother, typically occurs between the fourth and fifth months of pregnancy, around 18-20 weeks of gestation. Choice C is correct as it provides the client with accurate information about the expected timing of this significant milestone in her pregnancy. Choices A, B, and D are incorrect because quickening does not happen during the last trimester, by the end of the first trimester, or once the uterus begins to rise out of the pelvis. The correct timeframe for quickening is during the second trimester, specifically between the fourth and fifth months.

4. A client who is pregnant states that her last menstrual period was April 1st. What is the client's estimated date of delivery?

• A. January 8
• B. January 15
• C. February 8
• D. February 15

Correct answer: A

Rationale: To calculate the estimated date of delivery, add 7 days to the first day of the last menstrual period (April 1st), which gives April 8th. Then, count forward 9 months from April 8th, leading to January 8th as the estimated date of delivery. Choice A is correct. Choice B is incorrect because it is exactly 9 months from the last menstrual period without accounting for the additional 7 days. Choices C and D are incorrect as they fall in February, which is beyond the 9-month period from the last menstrual period.

5. While observing the electronic fetal heart rate monitor tracing for a client at 40 weeks of gestation in labor, a nurse should suspect a problem with the umbilical cord when she observes which of the following patterns?

• A. Early decelerations
• B. Accelerations
• C. Late decelerations
• D. Variable decelerations

Correct answer: D

Rationale: Variable decelerations can indicate umbilical cord compression, which is a concern that may arise due to the umbilical cord being compressed during labor. This compression can lead to reduced blood flow and oxygen delivery to the fetus, necessitating close monitoring and potentially interventions to alleviate the pressure on the cord. Early decelerations are typically benign and mirror the contractions, indicating fetal head compression. Accelerations are reassuring patterns that show a healthy response to fetal movement. Late decelerations are concerning as they suggest uteroplacental insufficiency, indicating potential oxygen deprivation to the fetus.

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