Nursing Elites

1. When developing an educational program for adolescents about nutrition during the third trimester of pregnancy, which of the following statements should be included?

• A. Consume three to four servings of dairy each day.
• B. Increase daily caloric intake by 600 to 700 calories.
• C. Limit daily sodium intake to less than 1 gram.
• D. Increase protein intake to 40 to 50 grams per day.

Correct answer: A

Rationale: The correct statement to include when developing an educational program for adolescents about nutrition during the third trimester of pregnancy is to consume three to four servings of dairy each day. Adequate calcium intake is crucial for bone development during pregnancy and helps prevent complications related to inadequate calcium intake. Increasing daily caloric intake by 600 to 700 calories (Choice B) is not necessary during the third trimester; excessive caloric intake can lead to unnecessary weight gain. Limiting daily sodium intake to less than 1 gram (Choice C) is not suitable during pregnancy, as some sodium intake is necessary for maintaining fluid balance. Increasing protein intake to 40 to 50 grams per day (Choice D) is important during pregnancy, but the emphasis in this case should be on calcium from dairy sources for bone development.

2. A client is 1 hour postpartum and the nurse observes a large amount of lochia rubra and several small clots on the client's perineal pad. The fundus is midline and firm at the umbilicus. Which of the following actions should the nurse take?

• A. Notify the healthcare provider.
• B. Increase the frequency of fundal massage.
• C. Encourage the client to empty their bladder.
• D. Document the findings and continue to monitor the client.

Correct answer: D

Rationale: In the postpartum period, the presence of lochia rubra and small clots along with a firm, midline fundus at the umbilicus is considered normal. In this situation, the appropriate action is to document the findings and continue to monitor the client. Changes in the amount and character of lochia, deviation of the fundus from the midline, or fundal height above or below the expected level may indicate a need for further intervention. Encouraging bladder emptying is important but not the priority in this scenario. Notify the healthcare provider if there are signs of abnormal postpartum bleeding or fundal abnormalities. Therefore, choice D is the correct answer. Choices A, B, and C are incorrect because at this stage, there are no signs of abnormality that require immediate notification of the healthcare provider, increased frequency of fundal massage, or immediate bladder emptying.

3. A client with a BMI of 26.5 is seeking advice on weight gain during pregnancy at the first prenatal visit. Which of the following responses should the nurse provide?

• A. It would be best if you gained about 11 to 20 pounds.
• B. The recommendation for you is about 15 to 25 pounds.
• C. A gain of about 25 to 35 pounds is recommended for you.
• D. A gain of about 1 pound per week is the best pattern for you.

Correct answer: B

Rationale: For a client with a BMI of 26.5 (overweight), the recommended weight gain during pregnancy is 15 to 25 pounds. This range helps promote a healthy pregnancy outcome and reduces the risk of complications associated with excessive weight gain. Option A suggests a lower weight gain range, which may not be adequate for a client with a BMI of 26.5. Option C indicates a higher weight gain range, which could lead to complications for an overweight individual. Option D provides a general guideline for weight gain without considering the client's BMI, which is not personalized advice. Therefore, the most appropriate response is option B, offering a suitable weight gain recommendation for the client's BMI to support a healthy pregnancy journey.

4. A client is exhibiting tearfulness, insomnia, lack of appetite, and a feeling of letdown after childbirth. Which of the following conditions is associated with these manifestations?

• A. Postpartum fatigue
• B. Postpartum psychosis
• C. Letting-go phase
• D. Postpartum blues

Correct answer: D

Rationale: The correct answer is D, Postpartum blues. Postpartum blues, also known as baby blues, are common after childbirth and are characterized by symptoms like tearfulness, insomnia, lack of appetite, and a feeling of letdown. This condition is typically self-limiting and resolves without specific treatment. Postpartum fatigue (choice A) refers to extreme tiredness after childbirth but does not typically include symptoms like tearfulness and insomnia. Postpartum psychosis (choice B) is a severe condition that includes symptoms such as hallucinations and delusions, which are not present in the scenario. The letting-go phase (choice C) does not represent a specific postpartum condition related to the symptoms described.

5. During an assessment of a client in labor who received epidural anesthesia, which finding should the nurse identify as a complication of the epidural block?

• A. Vomiting
• B. Tachycardia
• C. Respiratory depression
• D. Hypotension

Correct answer: D

Rationale: Hypotension is a common complication of epidural anesthesia due to the vasodilation effect of the medication. Epidural anesthesia can lead to vasodilation, causing a decrease in blood pressure. This hypotension may result in decreased perfusion to vital organs and compromise maternal and fetal well-being. Tachycardia is less likely as a complication of epidural anesthesia since it tends to have a vasodilatory effect. Respiratory depression is more commonly associated with other forms of anesthesia, such as general anesthesia, rather than epidural anesthesia. Vomiting is not typically a direct complication of epidural anesthesia and is more commonly seen with other factors such as pain or medications given during labor.

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