Nursing Elites

1. 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.

2. 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.

3. A full-term newborn is being assessed by a nurse 15 minutes after birth. Which of the following findings requires intervention by the nurse?

• A. Heart rate 168/min
• B. Respiratory rate 18/min
• C. Tremors
• D. Fine crackles

Correct answer: B

Rationale: A newborn's respiratory rate can vary between 20 to 100 breaths per minute during the initial phase after birth. A respiratory rate as low as 18 breaths per minute at this early stage requires immediate nursing intervention. This finding necessitates further assessment to ensure adequate oxygenation and respiratory function. The other options, heart rate of 168/min, tremors, and fine crackles, are within normal limits for a full-term newborn and do not require immediate intervention.

4. When reinforcing discharge teaching to the parents of a newborn regarding circumcision care, which statement made by a parent indicates an understanding of the teaching?

• A. The circumcision will heal within a couple of days.
• B. I should not remove the yellow mucus that will form.
• C. I will clean the penis with each diaper change.
• D. I will give him a tub bath within a couple of days.

Correct answer: C

Rationale: The correct answer is C because cleaning the penis with each diaper change is essential for preventing infection and promoting healing after circumcision. This practice helps maintain good hygiene and reduces the risk of complications. Removing the yellow mucus or giving a tub bath too soon can interfere with the healing process and increase the likelihood of infection. Choice A is incorrect because circumcision healing usually takes about a week or more, not just a couple of days. Choice B is incorrect because parents should gently clean the area, including removing any discharge or debris as part of proper care. Choice D is incorrect because tub baths should be avoided until the circumcision is fully healed to prevent infection.

5. A client in the antepartum unit is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

• A. Placenta previa
• B. Prolapsed cord
• C. Incompetent cervix
• D. Abruptio placentae

Correct answer: D

Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall, which can cause continuous abdominal pain and vaginal bleeding. In this scenario, the client's symptoms of sudden abdominal pain and vaginal bleeding are indicative of abruptio placentae, which requires immediate medical attention to prevent potential complications for both the client and the fetus. Placenta previa is characterized by painless vaginal bleeding in the third trimester, not sudden abdominal pain. Prolapsed cord presents with visible umbilical cord protruding from the vagina and is not associated with abruptio placentae symptoms. Incompetent cervix typically manifests as painless cervical dilation in the second trimester, not sudden abdominal pain and bleeding as seen in abruptio placentae.

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