Nursing Elites

1. A nurse is determining the fetal heart rate (FHR) and places the fetoscope on the mother's abdomen to count the FHR. The nurse simultaneously palpates the mother's radial pulse and notes that it is synchronized with the sounds heard through the fetoscope. Which action should the nurse take?

• A. Count the FHR for 60 seconds, ensuring that it is synchronized consistently with the mother's radial pulse.
• B. Move the fetoscope to another area on the mother's abdomen to locate the fetal heart.
• C. Ask the mother to lie still while both the FHR and the radial pulse rate are counted.
• D. Count the FHR for 30 seconds and then count the radial pulse rate of the mother for 30 seconds.

Correct answer: B

Rationale: When auscultating the fetal heart rate, the nurse would place the fetoscope on the maternal abdomen, over the fetal back. The nurse would then palpate the mother's radial pulse. If her pulse is synchronized with the sounds from the fetoscope, the nurse would move the fetoscope to another area on the mother's abdomen to locate the FHR. The nurse needs to be sure that the FHR is what is actually being heard. Other sounds that may be heard are the funic sound (blood flowing through the umbilical cord) and the uterine sound (blood flowing through the uterine vessels). The funic sound is synchronized with the FHR; the uterine sound is synchronized with the mother's pulse. Therefore, moving the fetoscope to a different area will help in accurately locating and counting the fetal heart rate. Choice A is incorrect because counting for 60 seconds without changing the position may not address the issue of accurately locating the FHR. Choice C is incorrect as it does not address the need to reposition the fetoscope to locate the fetal heart. Choice D is incorrect because counting the FHR and the radial pulse rate separately may not help in differentiating the two sounds.

2. A 65-year-old female client is experiencing postmenopausal bleeding. Which type of physician should this client be encouraged to see?

• A. a radiologist
• B. a gynecologist
• C. a physiatrist
• D. an oncologist

Correct answer: B

Rationale: A gynecologist is the appropriate physician for this scenario as they specialize in treating and managing diseases of the female reproductive system, including postmenopausal bleeding. Postmenopausal bleeding can indicate serious conditions such as endometrial cancer, which a gynecologist can evaluate and manage. A radiologist primarily evaluates X-rays and imaging studies, not directly involved in managing gynecological issues. A physiatrist is a specialist in physical medicine and rehabilitation, not related to gynecological concerns. An oncologist specializes in diagnosing and treating cancer, which is not the primary concern in this case of postmenopausal bleeding.

3. Following the change of shift report, when can or should the nurse's plan be altered or modified during the shift?

• A. halfway through the shift
• B. at the end of the shift before the nurse reports off
• C. when needs change
• D. after the top-priority tasks have been completed

Correct answer: C

Rationale: The correct answer is 'when needs change.' It is crucial for the nurse to remain adaptable and adjust the plan promptly when the patient's needs or condition change. Choice A, 'halfway through the shift,' may not align with the timing of when needs actually change, making it less optimal for plan modifications. Choice B, 'at the end of the shift before the nurse reports off,' is too late to address evolving needs effectively. Choice D, 'after the top-priority tasks have been completed,' limits the nurse's ability to respond promptly to changing priorities, as needs may shift before all top-priority tasks are finished.

4. The teaching plan for gay or lesbian parents who want to disclose their homosexuality to their children should include all of the following instructions except:

• A. disclose the information before the child knows or suspects.
• B. be comfortable with your sexual preference first.
• C. have the discussion in a quiet place where interruptions are unlikely.
• D. explain how your relationship with the child changes because of the discussion

Correct answer: D

Rationale: The correct answer is to explain how your relationship with the child changes because of the discussion. Children of gay and lesbian parents should be reassured that their relationship with their parent will not change due to the disclosure. Choices A, B, and C are all important aspects of the disclosure process. It is crucial to disclose the information before the child knows or suspects, be comfortable with your sexual preference first, and have the discussion in a quiet place to ensure a safe and open environment for communication. Explaining how the relationship with the child changes might create unnecessary anxiety or confusion. Children may have different reactions based on their age, understanding, and environment. Therefore, it is essential to maintain a sense of stability and security in the parent-child relationship while addressing any questions or concerns that may arise.

5. Mr. H. is upset about being in the hospital for another day because he states it costs too much. The rights he is likely to demand include all of the following except:

• A. the right to examine and question the bill
• B. the right to reasonable response to requests
• C. the right to refuse treatment
• D. the right to confidentiality

Correct answer: D

Rationale: Confidentiality is the maintenance of privacy of information, which is not directly related to the issue Mr. H. is facing. The question indicates that Mr. H. is concerned about the cost of staying in the hospital, which pertains more to financial aspects and the right to examine and question the bill. The right to a reasonable response to requests and the right to refuse treatment are also crucial patient rights that Mr. H. may demand in his current situation. Therefore, the correct answer is the right to confidentiality, as it is not specifically relevant to the scenario presented.

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