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 nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow.

• A. Palpate the fundus to identify the fetal part.
• B. Determine the location of the fetal back.
• C. Palpate for the fetal part presenting at the inlet.
• D. All of the Above

Correct answer: D

Rationale: The correct sequence for the nurse to follow when performing Leopold maneuvers is as follows: first, palpate the client's fundus to identify the fetal part, second, determine the location of the fetal back, third, palpate for the fetal part presenting at the inlet, and finally, palpate the cephalic prominence to identify the attitude of the head. Therefore, option D, 'All of the Above,' is the correct answer as it includes all the steps in the correct sequence. Choices A, B, and C are incorrect as they do not represent the complete sequence required for performing Leopold maneuvers.

3. A woman at 38 weeks of gestation is admitted in early labor with ruptured membranes. The nurse determines that the client's oral temperature is 38.9°C (102°F). Besides notifying the provider, which of the following is an appropriate nursing action?

• A. Recheck the client's temperature in 4 hours.
• B. Administer glucocorticoids intramuscularly.
• C. Assess the odor of the amniotic fluid.
• D. Prepare the client for emergency cesarean section.

Correct answer: C

Rationale: An elevated temperature in a woman with ruptured membranes may indicate infection. Assessing the odor of the amniotic fluid can help determine if chorioamnionitis (an infection of the amniotic fluid) is present. This assessment is crucial to guide further interventions and management of the client's condition. Options A, B, and D are incorrect. Rechecking the client's temperature in 4 hours does not address the immediate concern of potential infection. Administering glucocorticoids intramuscularly is not indicated based solely on an elevated temperature. Preparing the client for an emergency cesarean section is premature and not supported by the information provided.

4. A client who is at 22 weeks gestation is being educated by a nurse about the amniocentesis procedure. Which of the following statements should the nurse make?

• A. You will lie on your right side during the procedure.
• B. You should not eat anything for 24 hours before the procedure.
• C. You should empty your bladder before the procedure.
• D. The test is performed to determine gestational age.

Correct answer: C

Rationale: The correct answer is C. The nurse should advise the client to empty her bladder before an amniocentesis to minimize the risk of bladder puncture during the procedure. This precaution helps ensure the safety and accuracy of the procedure by reducing potential complications related to bladder puncture. Choices A, B, and D are incorrect because lying on the right side, fasting for 24 hours, and determining gestational age are not relevant instructions for an amniocentesis procedure.

5. A client who is at 42 weeks gestation and in labor asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make?

• A. Your baby will have excess baby fat.
• B. Your baby will have flat areola without breast buds.
• C. Your baby's heels will easily move to his ears.
• D. Your baby's skin will have a leathery appearance.

Correct answer: D

Rationale: The correct answer is D: 'Your baby's skin will have a leathery appearance.' Postmature infants, born after 42 weeks of gestation, may have a leathery appearance of the skin due to prolonged exposure to amniotic fluid. This occurs as the protective vernix caseosa is shed, and the skin loses its protective covering, leading to a wrinkled and dry appearance. Choices A, B, and C are incorrect. Excess baby fat is not a typical characteristic of postmature infants. Flat areola without breast buds and the ability of the baby's heels to easily move to his ears are not associated with postmaturity.

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