Nursing Elites

1. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

• A. Late decelerations
• B. Moderate variability of the FHR
• C. Cessation of uterine dilation
• D. Prolonged active phase of labor

Correct answer: A

Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.

2. A healthcare professional is preparing to administer magnesium sulfate 2 g/hr IV to a client who is in preterm labor. Available is 20 g of magnesium sulfate in 500 mL of dextrose 5% in water (D5W). How many mL/hr should the IV infusion pump be set to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

• A. 60
• B. 30
• C. 50
• D. 80

Correct answer: C

Rationale: To administer magnesium sulfate 2 g/hr IV, the healthcare professional should set the IV infusion pump to administer 50 mL/hr. The calculation is as follows: 20 g / 500 mL = 2 g / X mL, X = 50 mL/hr. Choice A (60 mL/hr) is incorrect as it does not match the calculated rate. Choice B (30 mL/hr) is incorrect as it is half of the calculated rate. Choice D (80 mL/hr) is incorrect as it is higher than the calculated rate.

3. An adolescent is being taught about levonorgestrel contraception by a school nurse. What information should the nurse include in the teaching?

• A. You should take the medication within 72 hours following unprotected sexual intercourse.
• B. Do not take this medication if you are on an oral contraceptive.
• C. If you do not start your period within 5 days of taking this medication, you will need a pregnancy test.
• D. One dose of this medication will prevent pregnancy for 14 days after taking it.

Correct answer: A

Rationale: Levonorgestrel is an emergency contraceptive that works by inhibiting ovulation to prevent conception. It is most effective when taken as soon as possible within 72 hours following unprotected sexual intercourse. Therefore, the nurse should instruct the adolescent to take the medication promptly to maximize its effectiveness. Choice B is incorrect because levonorgestrel can be used even if the individual is on oral contraceptives. Choice C is incorrect as the efficacy of levonorgestrel is not determined by the onset of menstruation. Choice D is incorrect because levonorgestrel is a single-dose emergency contraceptive and does not provide protection for 14 days after ingestion.

4. A client presents with uterine hypotonicity and postpartum hemorrhage. Which action should the nurse prioritize?

• A. Check the client's capillary refill.
• B. Massage the client's fundus.
• C. Insert an indwelling urinary catheter for the client.
• D. Prepare the client for a blood transfusion.

Correct answer: B

Rationale: In a client with uterine hypotonicity and postpartum hemorrhage, the priority is to address the risk of hypovolemic shock, which can lead to vital organ perfusion compromise and potentially death. Massaging the client's fundus helps to control bleeding by promoting uterine contraction and reducing blood loss, making it the nurse's priority intervention in this situation. Checking capillary refill may be important in assessing perfusion status but is not the priority over controlling the hemorrhage. Inserting an indwelling urinary catheter is not the priority in managing postpartum hemorrhage. Although preparing for a blood transfusion may be necessary, addressing the primary cause of bleeding by massaging the fundus takes precedence to stabilize the client's condition.

5. A healthcare professional is assessing a late preterm newborn. Which of the following clinical manifestations is an indication of hypoglycemia?

• A. Hypertonia
• B. Increased feeding
• C. Hyperthermia
• D. Respiratory distress

Correct answer: D

Rationale: The correct answer is D, respiratory distress, as it is a clinical manifestation of hypoglycemia in newborns. Other signs of hypoglycemia include an abnormal cry, jitteriness, lethargy, poor feeding, apnea, and seizures. Hypertonia, increased feeding, and hyperthermia are not typically associated with hypoglycemia in newborns. Hypertonia is more indicative of neurological issues, increased feeding is not a common sign of hypoglycemia, and hyperthermia is not a typical symptom of low blood sugar.

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