Nursing Elites

1. While observing the electronic fetal heart rate monitor tracing for a client at 40 weeks of gestation in labor, a nurse should suspect a problem with the umbilical cord when she observes which of the following patterns?

• A. Early decelerations
• B. Accelerations
• C. Late decelerations
• D. Variable decelerations

Correct answer: D

Rationale: Variable decelerations can indicate umbilical cord compression, which is a concern that may arise due to the umbilical cord being compressed during labor. This compression can lead to reduced blood flow and oxygen delivery to the fetus, necessitating close monitoring and potentially interventions to alleviate the pressure on the cord. Early decelerations are typically benign and mirror the contractions, indicating fetal head compression. Accelerations are reassuring patterns that show a healthy response to fetal movement. Late decelerations are concerning as they suggest uteroplacental insufficiency, indicating potential oxygen deprivation to the fetus.

2. When reinforcing teaching with new parents on bathing a newborn, a nurse observes a bluish-brown marking across the newborn's lower back. Which of the following statements should the nurse make concerning the variation?

• A. This is more commonly seen in newborns who have dark skin.
• B. This is a finding indicating hyperbilirubinemia.
• C. This is a forceps mark from an operative delivery.
• D. This is related to prolonged birth or trauma during delivery.

Correct answer: A

Rationale: A bluish-brown marking across the lower back is more commonly seen in newborns with dark skin. These markings are known as Mongolian spots and are benign. They are not related to hyperbilirubinemia, forceps marks, or trauma during delivery. Choice B is incorrect because hyperbilirubinemia presents as jaundice, not as a bluish-brown marking. Choice C is incorrect because forceps marks would have a different appearance and location. Choice D is incorrect as Mongolian spots are not related to prolonged birth or trauma during delivery.

3. A client is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation. The client asks the nurse about the purpose of this test. What explanation should the nurse provide?

• A. This test screens for neural tube defects and other developmental abnormalities in the fetus.
• B. It assesses various markers of fetal well-being.
• C. This test identifies an Rh incompatibility between the mother and fetus.
• D. It is a screening test for spinal defects in the fetus.

Correct answer: A

Rationale: The maternal serum alpha-fetoprotein (MSAFP) test is performed around 15-18 weeks of gestation to screen for neural tube defects and other developmental abnormalities in the fetus, not to assess fetal lung maturity, markers of fetal well-being, or Rh incompatibility between the mother and fetus. Choice A is the correct answer as it accurately reflects the purpose of the MSAFP test. Choices B, C, and D are incorrect because they do not align with the primary goal of this screening test.

4. A client is being educated by a healthcare provider about potential adverse effects of implantable progestins. Which of the following adverse effects should the healthcare provider include? (Select all that apply)

• A. Nausea
• B. Irregular vaginal bleeding
• C. Weight gain
• D. All of the Above

Correct answer: D

Rationale: When educating a client about implantable progestins, it is important to discuss potential adverse effects. Nausea, irregular vaginal bleeding, and weight gain are common side effects associated with implantable progestins. Therefore, clients should be informed about these possibilities to ensure they are aware of what to expect and when to seek medical attention if needed. Choice D, 'All of the Above,' is the correct answer because all of the listed adverse effects (nausea, irregular vaginal bleeding, and weight gain) should be included in the client education. Choices A, B, and C are incorrect because they individually do not encompass all the potential adverse effects that the healthcare provider should discuss with the client.

5. A healthcare provider is assessing a newborn who has a coarctation of the aorta. Which of the following should the provider recognize as a clinical manifestation of coarctation of the aorta?

• A. Increased blood pressure in the arms with decreased blood pressure in the legs
• B. Decreased blood pressure in the arms with increased blood pressure in the legs
• C. Increased blood pressure in both the arms and the legs
• D. Decreased blood pressure in both the arms and the legs

Correct answer: A

Rationale: The correct answer is increased blood pressure in the arms with decreased blood pressure in the legs. Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities due to decreased blood flow beyond the narrowing. Choice B is incorrect because coarctation of the aorta does not lead to increased blood pressure in the legs. Choice C is incorrect because increased blood pressure in both the arms and legs is not a typical manifestation of coarctation of the aorta. Choice D is incorrect because decreased blood pressure in both the arms and legs is not characteristic of coarctation of the aorta.

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