Nursing Elites

1. During a vaginal exam on a client in labor who reports severe pressure and pain in the lower back, a nurse notes that the fetal head is in a posterior position. Which of the following is the best nonpharmacological intervention for the nurse to perform to relieve the client's discomfort?

• A. Back rub
• B. Counter-pressure
• C. Playing music
• D. Foot massage

Correct answer: B

Rationale: In cases where the fetus is in a posterior position causing severe pressure and pain in the lower back during labor, applying counter-pressure is the most effective nonpharmacological intervention. Counter-pressure helps lift the fetal head off the spinal nerve, offering relief to the client. This technique is evidence-based and recommended to alleviate discomfort associated with a posterior fetal position. Choices A, C, and D are not as effective in this situation. While a back rub or playing music may provide some comfort, they do not directly address the issue caused by the fetal head's position. Similarly, a foot massage may offer relaxation but may not significantly relieve the specific discomfort arising from the posterior fetal position and the associated lower back pain.

2. When advising a woman considering pregnancy on nutritional needs to reduce the risk of giving birth to a newborn with a neural tube defect, what information should the nurse include?

• A. Limit alcohol consumption.
• B. Increase intake of iron-rich foods.
• C. Consume foods fortified with folic acid.
• D. Avoid foods containing aspartame.

Correct answer: C

Rationale: The correct answer is C: Consume foods fortified with folic acid. Folic acid plays a crucial role in preventing neural tube defects. It is advised to consume foods fortified with folic acid or take a supplement containing at least 400 micrograms of folic acid daily. This nutrient is essential for the developing fetus and can significantly reduce the risk of neural tube defects when taken before and during early pregnancy. Choices A, B, and D are incorrect. While limiting alcohol consumption is important during pregnancy, it is not directly related to reducing the risk of neural tube defects. Increasing intake of iron-rich foods is essential for preventing anemia but is not specifically linked to neural tube defects. Avoiding foods containing aspartame is generally recommended, but it is not directly related to reducing the risk of neural tube defects.

3. A client who underwent an amniotomy is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

• A. Maintain the client in the lithotomy position.
• B. Perform vaginal examinations frequently.
• C. Remind the client to bear down with each contraction.
• D. Encourage the client to empty her bladder every 2 hours.

Correct answer: D

Rationale: Encouraging the client to empty her bladder every 2 hours is essential during labor to prevent bladder distention, which can hinder labor progress and cause discomfort. A distended bladder can also lead to potential complications such as uterine atony or increased risk of infection. Choice A is incorrect as maintaining the client in the lithotomy position is not necessary during the active phase of the first stage of labor and may not be comfortable for the client. Choice B is incorrect because performing vaginal examinations frequently can increase the risk of introducing infection and disrupt the natural progress of labor. Choice C is incorrect as bearing down with each contraction is typically reserved for the second stage of labor when the cervix is fully dilated, not during the active phase of the first stage.

4. A healthcare provider in a clinic is reinforcing teaching with a client of childbearing age about recommended folic acid supplements. Which of the following defects can occur in the fetus or neonate as a result of folic acid deficiency?

• A. Iron deficiency anemia
• B. Poor bone formation
• C. Macrosomic fetus
• D. Neural tube defects

Correct answer: D

Rationale: The correct answer is D: Neural tube defects. Folic acid deficiency during pregnancy can lead to neural tube defects in the fetus, affecting the brain, spine, or spinal cord development. Iron deficiency anemia (choice A) is not directly related to folic acid deficiency. Poor bone formation (choice B) is more associated with calcium and vitamin D deficiencies. Macrosomic fetus (choice C) refers to a baby with excessive birth weight and is not a typical outcome of folic acid deficiency in pregnancy. Therefore, it is crucial for individuals of childbearing age to take recommended folic acid supplements to prevent neural tube defects.

5. A client at 28 weeks of gestation received terbutaline. Which of the following findings should the nurse expect?

• A. Fetal heart rate 100/min
• B. Weakened uterine contractions
• C. Enhanced production of fetal lung surfactant
• D. Maternal blood glucose 63 mg/dL

Correct answer: B

Rationale: Terbutaline is a tocolytic medication that works by relaxing the uterine muscles, leading to weakened uterine contractions. This effect helps to prevent preterm labor. Therefore, the nurse should expect weakened uterine contractions in a client who has received terbutaline at 28 weeks of gestation. Choices A, C, and D are incorrect. Terbutaline administration would not directly affect the fetal heart rate, enhance fetal lung surfactant production, or cause maternal hypoglycemia.

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