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. A client in labor requests epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care?

• A. Position the client supine for 30 minutes after the first dose of anesthetic solution.
• B. Administer 1,000 mL of dextrose 5% in water after the first dose of anesthetic solution.
• C. Monitor the client's blood pressure every 5 minutes after the first dose of anesthetic solution.
• D. Ensure the client has been NPO for 4 hours before the placement of the epidural and the first dose of anesthetic solution.

Correct answer: C

Rationale: The correct action is to monitor the client's blood pressure every 5 to 10 minutes following the first dose of anesthetic solution to assess for maternal hypotension. This is crucial to detect and manage potential complications associated with the epidural anesthesia. Positioning the client supine for a prolonged period can lead to hypotension; administering dextrose solution is not a standard practice in epidural anesthesia; ensuring NPO status for 4 hours is not necessary before epidural placement.

3. A healthcare provider in a clinic is reinforcing teaching with a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency?

• A. Iron deficiency anemia
• B. Poor bone formation
• C. Macrosomic fetus
• D. Neural tube defects

Correct answer: D

Rationale: The correct answer is D: Neural tube defects. Folic acid deficiency during pregnancy can lead to neural tube defects in the fetus, affecting the brain, spine, or spinal cord development. Iron deficiency anemia (choice A) is not directly related to folic acid deficiency. Poor bone formation (choice B) is more associated with calcium and vitamin D deficiencies. Macrosomic fetus (choice C) refers to a baby with excessive birth weight and is not a typical outcome of folic acid deficiency in pregnancy. Therefore, it is crucial for individuals of childbearing age to take recommended folic acid supplements to prevent neural tube defects.

4. When reinforcing teaching with a group of new parents about proper techniques for bottle feeding, which of the following instructions should be provided?

• A. Burp the newborn at the end of the feeding
• B. Hold the newborn close in a supine position
• C. Keep the nipple full of formula throughout the feeding
• D. Refrigerate any unused formula

Correct answer: C

Rationale: The correct technique for bottle feeding includes keeping the nipple full of formula throughout the feeding to prevent air from entering the baby's stomach. This helps reduce the risk of the baby swallowing air, which can lead to discomfort and colic. Therefore, maintaining a full nipple during feeding is essential for the baby's comfort and digestion. Option A is incorrect as burping should be done during the feeding to prevent excessive air intake. Option B is incorrect as the baby should be held semi-upright, not in a supine position, to reduce the risk of choking and ear infections. Option D is irrelevant to the feeding process and does not contribute to the baby's well-being.

5. A client who is postpartum has a slightly boggy and displaced fundus to the right. Which of the following actions should the nurse take based on these findings?

• A. Encourage the client to perform Kegel exercises.
• B. Encourage the client to move to the left lateral position.
• C. Ask the client to rate her pain.
• D. Assist the client to the bathroom to void.

Correct answer: D

Rationale: A displaced and boggy fundus in a postpartum client typically indicates a full bladder, which can impede uterine contractions and increase the risk of postpartum hemorrhage. Assisting the client to the bathroom to void helps ensure the bladder is empty, aiding the fundus to contract and reducing the risk of complications. Encouraging Kegel exercises, changing positions, or assessing pain would not directly address the issue of the boggy fundus caused by a full bladder.

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