Nursing Elites

1. A nurse is caring for a client who is at 38 weeks of gestation and is experiencing continuous abdominal pain and vaginal bleeding. The client has a history of cocaine use. The nurse should identify that the client is likely experiencing which of the following complications?

• A. Abruptio placentae
• B. Hydatidiform mole
• C. Preterm labor
• D. Placenta previa

Correct answer: A

Rationale: Continuous abdominal pain and vaginal bleeding in a client with a history of cocaine use suggest abruptio placentae, where the placenta detaches from the uterus prematurely, posing serious risks to both mother and fetus. Hydatidiform mole is characterized by abnormal trophoblastic tissue growth, not continuous pain and bleeding. Preterm labor is premature contractions leading to birth before 37 weeks gestation. Placenta previa involves the placenta partially or completely covering the cervix, presenting with painless vaginal bleeding.

2. A nurse is reviewing the laboratory results of a newborn who is 24 hours old. Which of the following findings should the nurse report to the provider?

• A. Hemoglobin 12 g/dL
• B. Glucose 50 mg/dL
• C. Bilirubin 4 mg/dL
• D. Platelets 200,000/mm³

Correct answer: C

Rationale: The correct answer is C: Bilirubin 4 mg/dL. A bilirubin level of 4 mg/dL is elevated for a newborn and requires monitoring and potential intervention to prevent complications such as jaundice and kernicterus. Elevated bilirubin levels in newborns can lead to serious neurological consequences. Choices A, B, and D are within normal ranges for a newborn and do not require immediate reporting to the provider. Therefore, the nurse should prioritize reporting the elevated bilirubin level to the provider for further evaluation and management.

3. A nurse is preparing to administer ampicillin 500 mg in 50 mL of dextrose 5% in water (D5W) to infuse over 15 min. The drop factor of the manual IV tubing is 10 gtt/mL. How many gtt/min should the nurse set the manual IV infusion to deliver?

• A. 30 gtt/min
• B. 32 gtt/min
• C. 33 gtt/min
• D. 35 gtt/min

Correct answer: C

Rationale: Calculation: 10 gtt/mL × 50 mL ÷ 15 min = 33.33, rounded to 33 gtt/min. This ensures proper delivery of the medication over the prescribed time. Choice A is incorrect because it does not factor in the precise calculation based on the given data. Choice B is incorrect as it does not reflect the accurate rate of infusion required. Choice D is incorrect as it does not align with the correct calculation based on the drop factor and infusion parameters provided in the question.

4. A nurse enters a client’s room and sees smoke coming from the trash can. Which action should the nurse take first?

• A. Extinguish the fire
• B. Activate the fire alarm
• C. Evacuate the room
• D. Call the client’s family

Correct answer: C

Rationale: In a fire emergency, the priority for the nurse is to ensure safety. The correct first action is to evacuate the room, following the RACE protocol, which stands for Rescue, Alarm, Contain, and Extinguish/Evacuate. Activating the fire alarm alerts others, extinguishing the fire can escalate the situation if not done correctly, and calling the client's family is not a priority in this emergency scenario.

5. A client is receiving vancomycin. Which of the following should the nurse monitor?

• A. Blood glucose levels
• B. Serum creatinine
• C. INR levels
• D. Liver function tests

Correct answer: B

Rationale: The correct answer is B: Serum creatinine. Vancomycin is known to be nephrotoxic, meaning it can cause kidney damage. Monitoring serum creatinine levels is essential to assess kidney function and detect any signs of nephrotoxicity. Blood glucose levels (choice A) are not directly affected by vancomycin. INR levels (choice C) are typically monitored for clients on anticoagulants, not vancomycin. Liver function tests (choice D) are not primarily affected by vancomycin use; kidney function is of greater concern.

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