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. When reviewing the electronic medical record of a postpartum client, which of the following factors places the client at risk for infection?

• A. Meconium-stained amniotic fluid
• B. Placenta previa
• C. Midline episiotomy
• D. Gestational hypertension

Correct answer: C

Rationale: The correct answer is C: Midline episiotomy. An episiotomy is a surgical incision made during childbirth to enlarge the vaginal opening. This procedure increases the risk of infection in the postpartum period due to the incision site being a potential entry point for pathogens. Meconium-stained amniotic fluid (choice A) is a risk factor for fetal distress but does not directly increase the mother's risk of infection. Placenta previa (choice B) is a condition where the placenta partially or completely covers the cervix, leading to potential bleeding issues but not necessarily an increased risk of infection. Gestational hypertension (choice D) is a hypertensive disorder that affects some pregnant women but is not directly associated with an increased risk of infection in the postpartum period.

3. Which of the following statements is true of mutations?

• A. Mutations can only occur by chance.
• B. Mutations produce sperm and ova cells.
• C. Mutations occur through radiation or other environmental influences.
• D. Mutations help adenine combine with guanine to form the single spiral structure of DNA.

Correct answer: C

Rationale: The correct answer is C. Mutations can occur due to environmental influences such as radiation, chemicals, or other external factors, leading to changes in the DNA sequence. Choice A is incorrect because mutations can also occur due to errors in DNA replication, not solely by chance. Choice B is incorrect as mutations affect the DNA sequence itself, not the production of specific cells. Choice D is incorrect because mutations involve changes in the DNA sequence and do not specifically involve the formation of the DNA structure.

4. A newborn is 1 hour old with a respiratory rate of 50/min, a heart rate of 130/min, and an axillary temperature of 36.1°C (97°F). Which of the following actions should be taken?

• A. Give the newborn a warm bath.
• B. Apply a cap to the newborn's head.
• C. Reposition the newborn.
• D. Obtain an oxygen saturation level.

Correct answer: B

Rationale: Applying a cap to the newborn's head is the correct action in this scenario. Newborns are at risk of heat loss due to their high surface area to volume ratio, and maintaining their body temperature is crucial to prevent hypothermia. Giving a warm bath can further increase heat loss and is not recommended. Repositioning the newborn may not address the primary concern of temperature regulation. While monitoring oxygen saturation is important, addressing thermal regulation takes precedence in this situation.

5. A 30-year-old primigravida delivers a nine-pound (4082 gram) infant vaginally after a 30-hour labor. What is the priority nursing action for this client?

• A. Assess the blood pressure for hypertension.
• B. Gently massage fundus every four hours.
• C. Observe for signs of uterine hemorrhage.
• D. Encourage direct contact with the infant.

Correct answer: C

Rationale: After a prolonged labor and delivery of a large infant, the client is at an increased risk for uterine atony and postpartum hemorrhage, making observation for signs of bleeding a priority. Assessing the blood pressure for hypertension (Choice A) is not the priority in this situation as the immediate concern is postpartum hemorrhage. Gently massaging the fundus every four hours (Choice B) is a routine postpartum care activity but is not the priority in this scenario. Encouraging direct contact with the infant (Choice D) is important for bonding but does not address the immediate risk of uterine hemorrhage after delivery.

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