Nursing Elites

1. A client is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take?

• A. Place a snug dressing on the client’s nipple when not breastfeeding
• B. Ensure the newborn’s mouth is wide open before latching to the breast
• C. Encourage the client to limit the newborn’s feeding to 10 minutes on each breast
• D. Instruct the client to begin the feeding with the nipple that is most tender

Correct answer: B

Rationale: Ensuring the newborn's mouth is wide open before latching is crucial for achieving a proper latch, which can help reduce nipple soreness. Placing a snug dressing on the nipple when not breastfeeding (choice A) can lead to further irritation and hinder healing. Encouraging the client to limit the newborn’s feeding to 10 minutes on each breast (choice C) may not be adequate for effective feeding as infants should feed until they are satisfied. Instructing the client to begin feeding with the most tender nipple (choice D) can worsen the soreness as it may not allow the baby to feed effectively.

2. A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light and asks for her nurse right away, stating 'I’m bleeding a lot.' What is the most likely cause of postpartum hemorrhage in this client?

• A. Retained placental fragments.
• B. Unrepaired vaginal lacerations.
• C. Uterine atony.
• D. Puerperal infection.

Correct answer: C

Rationale: Uterine atony is the most likely cause of bleeding 4 hours after delivery, especially after delivering a macrosomic infant and augmenting labor with oxytocin. Uterine atony is characterized by the inability of the uterine muscles to contract effectively after childbirth, leading to excessive bleeding. The other options, such as retained placental fragments (A), unrepaired vaginal lacerations (B), and puerperal infection (D), are less likely causes of postpartum hemorrhage in this scenario. Retained placental fragments can cause bleeding, but this typically presents earlier than 4 hours postpartum. Unrepaired vaginal lacerations would likely be evident sooner and not typically result in significant bleeding. Puerperal infection is not a common cause of immediate postpartum hemorrhage unless there are other signs of infection present.

3. A nurse on an antepartum unit is reviewing the medical records for four clients. Which of the following clients should the nurse assess first?

• A. A client who has diabetes mellitus and an HbA1c of 5.8%
• B. A client who has preeclampsia and a creatinine level of 1.1 mg/dL
• C. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L
• D. A client who has placenta previa and a hematocrit of 36%

Correct answer: C

Rationale: A sodium level of 110 mEq/L is critically low and can indicate severe dehydration and electrolyte imbalance, requiring immediate intervention.

4. A healthcare professional is caring for a client who is 14 weeks of gestation. At which of the following locations should the healthcare professional place the Doppler device when assessing the fetal heart rate?

• A. Midline 2 to 3 cm (0.8 to 1.2 in) above the symphysis pubis
• B. Left Upper Abdomen
• C. Two fingerbreadths above the umbilicus
• D. Lateral at the Xiphoid Process

Correct answer: A

Rationale: At 14 weeks of gestation, the uterus is still relatively low in the abdomen. Placing the Doppler midline 2 to 3 cm above the symphysis pubis is appropriate for assessing the fetal heart rate. This location allows for better detection of the fetal heart tones as the uterus is at a lower position during this stage of pregnancy. Placing the Doppler on the left upper abdomen would not be ideal at 14 weeks gestation as the uterus is not yet at that level. Placing it two fingerbreadths above the umbilicus or lateral at the xiphoid process would also not be accurate for locating the fetal heart rate at this stage of gestation.

5. A healthcare professional is planning care for a full-term newborn who is receiving phototherapy. Which of the following actions should the healthcare professional include in the plan of care?

• A. Dress the newborn in lightweight clothing.
• B. Avoid using lotion or ointment on the newborn's skin.
• C. Keep the newborn supine throughout treatment.
• D. Measure the newborn's temperature every 8 hours.

Correct answer: B

Rationale: When a newborn is receiving phototherapy, it is important to avoid using lotions or ointments on their skin as these products can lead to skin irritation and burns under the phototherapy lights. Dressing the newborn in lightweight clothing helps ensure proper exposure to the phototherapy lights. Keeping the newborn supine during treatment helps maximize exposure to the light. However, the key consideration in this scenario is to prevent skin irritation and burns by avoiding lotions or ointments.

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