Nursing Elites

1. A client presents with uterine hypotonicity and postpartum hemorrhage. Which action should the nurse prioritize?

• A. Check the client's capillary refill.
• B. Massage the client's fundus.
• C. Insert an indwelling urinary catheter for the client.
• D. Prepare the client for a blood transfusion.

Correct answer: B

Rationale: In a client with uterine hypotonicity and postpartum hemorrhage, the priority is to address the risk of hypovolemic shock, which can lead to vital organ perfusion compromise and potentially death. Massaging the client's fundus helps to control bleeding by promoting uterine contraction and reducing blood loss, making it the nurse's priority intervention in this situation. Checking capillary refill may be important in assessing perfusion status but is not the priority over controlling the hemorrhage. Inserting an indwelling urinary catheter is not the priority in managing postpartum hemorrhage. Although preparing for a blood transfusion may be necessary, addressing the primary cause of bleeding by massaging the fundus takes precedence to stabilize the client's condition.

2. A nurse is caring for a preterm newborn who is in an incubator to maintain a neutral thermal environment. The father of the newborn asks the nurse why this is necessary. Which of the following responses should the nurse make?

• A. Preterm newborns have a smaller body surface area than normal newborns.
• B. The added brown fat layer in a preterm newborn reduces his ability to generate heat.
• C. Preterm newborns lack adequate temperature control mechanisms.
• D. The heat in the incubator rapidly dries the sweat of preterm newborns.

Correct answer: C

Rationale: The correct answer is C because preterm newborns have immature temperature regulation mechanisms, making it difficult for them to maintain their body temperature. An incubator helps maintain a stable thermal environment. Choice A is incorrect as the body surface area is not the primary reason for needing an incubator. Choice B is incorrect because brown fat in preterm newborns actually helps generate heat. Choice D is incorrect as the purpose of the incubator is not to dry sweat but to regulate the newborn's temperature.

3. 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.

4. A client who is at 36 weeks of gestation and has a prescription for a nonstress test is being taught by a nurse. Which of the following statements should the nurse include in the teaching?

• A. You will receive IV fluid before this test.
• B. The procedure will take approximately 10 to 15 minutes.
• C. You will be offered orange juice to drink during the test.
• D. You will need to sign an informed consent form before each test.

Correct answer: C

Rationale: The correct statement the nurse should include in the teaching is that the client will be offered orange juice to drink during the nonstress test. This is because offering the client orange juice, or another beverage high in glucose, will help stimulate the fetus during the procedure, aiding in obtaining accurate results. Choice A is incorrect because IV fluid is not typically administered before a nonstress test. Choice B is incorrect as the procedure usually takes around 20 to 40 minutes. Choice D is incorrect as informed consent is typically obtained once for the procedure, not before each individual test.

5. A nurse is caring for a client who is at 40 weeks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate?

• A. Epidural analgesia
• B. Naloxone hydrochloride
• C. Attention-focusing
• D. Pudendal nerve block

Correct answer: C

Rationale: Attention-focusing and distraction techniques are types of nonpharmacological care that are effective in relieving labor pain.

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