Nursing Elites

1. A nurse is explaining a nonstress test to a pregnant client. The nurse explains that the results are nonreactive if which finding is noted on the electronic monitoring recording strip?

• A. Two fetal heart accelerations within a 20-minute period, peaking at 15 beats/min above baseline and lasting 15 seconds from baseline to baseline
• B. Accelerations without fetal movement with fetal heart rate (FHR) increases of 15 beats/min for 15 seconds
• C. Acceleration of the FHR by 25 to 30 beats/min for at least 15 seconds in response to fetal movement
• D. Absence of accelerations after fetal movement

Correct answer: D

Rationale: The correct answer is 'Absence of accelerations after fetal movement.' In a nonreactive (nonreassuring) stress test, the monitor recording would not show accelerations after fetal movement within a 40-minute period. This absence of accelerations indicates a nonreactive result. Choices A, B, and C describe different patterns of fetal heart rate accelerations that are not indicative of a nonreactive result in a nonstress test, making them incorrect. Choice A describes the characteristics of a reactive (reassuring) result, where there should be at least two fetal heart accelerations within a 20-minute period, peaking at least 15 beats/min above the baseline, and lasting 15 seconds from baseline to baseline. Choice B incorrectly states 'Accelerations without fetal movement,' which is contradictory. Choice C describes an acceleration response to fetal movement, which does not signify a nonreactive result.

2. While assessing a client’s skin, the nurse notes the presence of several large red-blue and purple areas on the client’s body that do not blanch when pressure is applied. The nurse documents this finding using which term?

• A. Psoriasis
• B. Anasarca
• C. Petechiae
• D. Ecchymosis

Correct answer: D

Rationale: Ecchymosis refers to a large patch of capillary bleeding into the tissues, commonly known as a bruise. The color of such an area changes from red-blue or purple to green, yellow, and brown before the area disappears. Pressure on the area will not cause it to blanch. Psoriasis is characterized by scaly erythematous patches with silvery scales on top, usually found on specific areas like the scalp, elbows, knees, low back, and anogenital area. Anasarca is bilateral or generalized edema, indicating a central problem like congestive heart failure or kidney failure. Petechiae are tiny purple or red spots resulting from tiny hemorrhages within the dermal and subdermal areas. Therefore, in this case, the correct term to document the described finding is Ecchymosis.

3. When caring for a patient who is hard-of-hearing, which of the following steps may be appropriate when communicating with the patient?

• A. Divide the verbal communication into smaller sections and address one at a time.
• B. Communicate only with written information.
• C. Ask multiple questions in a row quickly to make sure the patient is remaining engaged.
• D. Frequently communicate without assistive devices to help the patient improve their hearing.

Correct answer: A

Rationale: When caring for a patient who is hard-of-hearing, it is important to divide verbal communication into smaller sections and address them one at a time. This approach helps the patient follow along more easily and understand the information being conveyed. While using written information can also be beneficial, solely relying on written communication may not always be practical or feasible for effective interaction. Asking multiple questions quickly can overwhelm the patient and hinder their ability to process each question adequately. It is essential to give the patient sufficient time to comprehend and respond. Additionally, frequently communicating without assistive devices is not recommended. Using assistive devices can significantly enhance the patient's ability to hear and understand, promoting better communication and patient care.

4. A client is scheduled to undergo a Papanicolaou (Pap) test in 1 week. Which statement does the nurse make to the client?

• A. 'If you are menstruating, use pads instead of a tampon.'
• B. 'Avoid intercourse for 24 hours before the scheduled examination.'
• C. 'Get a douching kit from the pharmacy and douche 2 hours before the examination.'
• D. 'If you are having a vaginal discharge, obtain a sample of the discharge for inspection.'

Correct answer: B

Rationale: The correct answer is to 'Avoid intercourse for 24 hours before the scheduled examination.' The Pap test is used to screen for cervical cancer. It is not performed during menstruation or if a heavy infectious discharge is present. Before the test, the client should not douche, have intercourse, or insert anything into the vagina within 24 hours. Instructing the client to use pads instead of a tampon when menstruating can interfere with the test results due to the presence of blood. Douching before the exam is discouraged as it can alter the cervical cells' appearance, affecting the test's accuracy. Obtaining a sample of vaginal discharge for inspection is not a standard pre-Pap test instruction and is unnecessary for the test.

5. During a routine health screening for a 1-year-old child, what is the most critical topic for the nurse to discuss with the parents?

• A. the potential hazards of accidents
• B. appropriate nutrition now that the child has been weaned from breastfeeding
• C. toilet training
• D. how to purchase appropriate shoes now that the child is walking

Correct answer: A

Rationale: During a routine health screening for a 1-year-old child, the most critical topic for the nurse to discuss with the parents is the potential hazards of accidents. Accidents are the primary source of injury in children and can be life-threatening. Discussions about appropriate nutrition should have been addressed during the weaning process, while the purchase of appropriate shoes is important but not life-threatening. Toilet training typically begins around 2 years of age, so 1 year of age is too early to discuss it. Therefore, the focus should be on educating parents about accident prevention to ensure the child's safety and well-being.

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