Nursing Elites

1. A client is scheduled for a cesarean birth based on fetal lung maturity. Which finding indicates that the fetal lungs are mature?

• A. Absence of Phosphatidylglycerol (PG)
• B. Biophysical profile score of 8
• C. Lecithin/sphingomyelin (L/S) ratio of 2:1
• D. Reactive nonstress test

Correct answer: C

Rationale: An L/S ratio of 2:1 indicates fetal lung maturity, as it signifies the presence of surfactant in the amniotic fluid, which helps with lung expansion and prevents collapse at the end of expiration. The absence of PG indicates immaturity of the fetal lungs, as PG appears in the amniotic fluid during the later stages of lung maturation. Biophysical profile scores and nonstress tests are assessments of fetal well-being and do not directly indicate fetal lung maturity. Therefore, choice C is the correct answer.

2. When providing care for a client in preterm labor at 32 weeks of gestation, which medication should the nurse anticipate the provider will prescribe to hasten fetal lung maturity?

• A. Calcium gluconate
• B. Indomethacin
• C. Nifedipine
• D. Betamethasone

Correct answer: D

Rationale: Betamethasone is the correct medication to anticipate the provider prescribing to hasten fetal lung maturity in clients at risk for preterm labor. It is a corticosteroid that helps promote lung maturation in the preterm fetus by stimulating the production of surfactant, which is essential for lung function. This medication is commonly given to pregnant individuals at risk of preterm delivery between 24 and 34 weeks of gestation to reduce the risk of respiratory distress syndrome in the newborn. Calcium gluconate, Indomethacin, and Nifedipine are not used to hasten fetal lung maturity in preterm labor; they serve different purposes in maternal and fetal care.

3. A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, 'I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device.' The nurse should suspect which of the following?

• A. Missed abortion
• B. Ectopic pregnancy
• C. Severe preeclampsia
• D. Hydatidiform mole

Correct answer: B

Rationale: Ectopic pregnancy should be suspected in clients with abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding, especially if they have an intrauterine device (IUD). In this case, the client's symptoms are classic for ectopic pregnancy, where the fertilized egg implants outside the uterus, commonly in the fallopian tube. Missed abortion (choice A) refers to a nonviable embryo or fetus in the uterus, which is not consistent with the client's presentation. Severe preeclampsia (choice C) is characterized by hypertension and proteinuria, not the symptoms described. Hydatidiform mole (choice D) presents with vaginal bleeding but typically lacks abdominal pain and is not related to the presence of an IUD.

4. When assessing newborn reflexes, what action should be taken to elicit the Moro reflex?

• A. Perform a sharp hand clap near the infant.
• B. Hold the newborn vertically allowing one foot to touch the table surface.
• C. Place a finger at the base of the newborn's toes.
• D. Turn the newborn's head quickly to one side.

Correct answer: A

Rationale: The correct answer is A: Perform a sharp hand clap near the infant. The Moro reflex, also known as the startle reflex, is elicited by a sudden stimuli such as a sharp hand clap near the infant. This reflex is characterized by the infant's arms extending and then flexing with a distinctive 'startle' motion. It is a normal and expected reflex in newborns, typically disappearing by 3-6 months of age. Choices B, C, and D are incorrect because they do not elicit the Moro reflex; holding the newborn vertically (choice B) or placing a finger at the base of the newborn's toes (choice C) are associated with other reflexes, while turning the newborn's head quickly to one side (choice D) is related to the tonic neck reflex.

5. A woman in a women's health clinic is receiving teaching about nutritional intake during her 8th week of gestation. The healthcare provider should advise the woman to increase her daily intake of which of the following nutrients?

• A. Calcium
• B. Vitamin E
• C. Iron
• D. Vitamin D

Correct answer: C

Rationale: During pregnancy, the recommended daily iron intake is higher compared to non-pregnant women. Pregnant women should aim for 27 mg/day of iron, while non-pregnant women require 15 mg/day if under 19 years old and 18 mg/day if between 19 and 50 years old. Iron is essential during pregnancy to support the increased blood volume and ensure the proper oxygen supply to the fetus. Calcium is important for bone health but does not need a significant increase during early pregnancy. Vitamin E and Vitamin D are important but do not have specific increases recommended during the 8th week of gestation.

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