Nursing Elites

1. When determining a fetal heart rate (FHR) and noting accelerations from the baseline rate when the fetus is moving, a nurse interprets this finding as:

• A. A reassuring sign
• B. An indication of the need to contact the physician
• C. An indication of fetal distress
• D. A nonreassuring sign

Correct answer: A

Rationale: When a nurse notes accelerations from the baseline rate of the fetal heart rate, particularly when they occur with fetal movement, it is considered a reassuring sign. This indicates a healthy response to fetal activity. Reassuring signs in FHR monitoring include an average rate between 120 and 160 beats/min at term, a regular rhythm with slight fluctuations, accelerations from the baseline rate (often associated with fetal movement), and the absence of decreases from the baseline rate. Choices B, C, and D are incorrect because accelerations in FHR with fetal movement are not indicative of the need to contact the physician, fetal distress, or a nonreassuring sign. These signs would typically be associated with other abnormal FHR patterns that would warrant further assessment and intervention.

2. When teaching parents how their children learn sex role identification, the nurse should include which of the following statements?

• A. Sex role identification begins in infancy.
• B. Sex role identification begins in the preschool years.
• C. Sex role identification begins during the school-age years.
• D. Sex role identification begins during early adolescence.

Correct answer: A

Rationale: Sex role identification begins during infancy as infants can identify body parts by the end of the first year. Preschoolers often engage in masturbation and sex play. School-age children continue to develop awareness of their sexual identity, including behaviors like hugging and kissing. Early adolescence sees further development influenced by sexual maturation and experimentation with sex roles. Therefore, the correct statement is that sex role identification begins in infancy. Choices B, C, and D are incorrect as they misrepresent the timeline of the development of sex role identification in children.

3. All of the following are common reasons that nurses are reluctant to delegate except:

• A. lack of self-confidence.
• B. desire to maintain authority.
• C. confidence in subordinates.
• D. getting trapped in the 'I can do it better myself' mindset.

Correct answer: C

Rationale: The correct answer is 'confidence in subordinates.' If a delegator has confidence in their subordinates' abilities, they are more likely to delegate tasks. Reasons why nurses are reluctant to delegate include their own lack of self-confidence, the desire to maintain authority, and getting trapped in the 'I can do it better myself' mindset. Therefore, having confidence in subordinates is not a common reason for reluctance to delegate.

4. According to Erik Erikson's developmental theory, which choice is a developmental task of the middle adult?

• A. Redefining self-perception and capacity for intimacy
• B. Making decisions concerning career, marriage, and parenthood
• C. Providing guidance during interactions with his children
• D. Verbalizing readiness to assume parental responsibilities

Correct answer: C

Rationale: According to Erikson's developmental theory, the primary developmental task of the middle adult is to achieve generativity. Generativity is the willingness to care for and guide others. Middle adults can achieve generativity with their own children or the children of close friends or through guidance in social interactions with the next generation. Providing guidance during interactions with his children aligns with this developmental task. Choices A, B, and D are not specific to the middle adult stage as they are tasks associated with young adults. Redefining self-perception and capacity for intimacy, making decisions concerning career, marriage, and parenthood, and verbalizing readiness to assume parental responsibilities are all developmental tasks of the young adult according to Erikson's theory.

5. A pregnant client is scheduled to undergo a transabdominal ultrasound, and the nurse provides information to the client about the procedure. The nurse provides which information?

• A. The procedure typically takes 10 to 30 minutes.
• B. She may need to drink fluids before the test and may not void until the test has been completed.
• C. A probe coated with gel will be inserted into the vagina.
• D. She will be positioned on her back, with her head elevated and turned slightly to one side.

Correct answer: B

Rationale: The correct answer is that the client may need to drink fluids before the test and may not void until the test has been completed. For a transabdominal ultrasound, the woman is positioned on her back with her head elevated and turned slightly to one side to prevent supine hypotension. A wedge or rolled blanket is placed under one hip to help her maintain this position comfortably. If a full bladder is necessary, the woman is instructed to drink several glasses of clear fluid 1 hour before the test and told that she should not void until the test has been completed. Warm mineral oil or transmission gel is spread over her abdomen, and the sonographer slowly moves a transducer over the abdomen to obtain a picture. The procedure typically takes 10 to 30 minutes, making choice A incorrect. Choice C is incorrect because a probe is not inserted into the vagina for a transabdominal ultrasound. Choice D is incorrect because the woman is positioned on her back with her head elevated and turned slightly to one side, not specifically on her back.

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