Nursing Elites

1. A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow.

• A. Palpate the fundus to identify the fetal part.
• B. Determine the location of the fetal back.
• C. Palpate for the fetal part presenting at the inlet.
• D. All of the Above

Correct answer: D

Rationale: The correct sequence for the nurse to follow when performing Leopold maneuvers is as follows: first, palpate the client's fundus to identify the fetal part, second, determine the location of the fetal back, third, palpate for the fetal part presenting at the inlet, and finally, palpate the cephalic prominence to identify the attitude of the head. Therefore, option D, 'All of the Above,' is the correct answer as it includes all the steps in the correct sequence. Choices A, B, and C are incorrect as they do not represent the complete sequence required for performing Leopold maneuvers.

2. A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, 'I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device.' The nurse should suspect which of the following?

• A. Missed abortion
• B. Ectopic pregnancy
• C. Severe preeclampsia
• D. Hydatidiform mole

Correct answer: B

Rationale: Ectopic pregnancy should be suspected in clients with abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding, especially if they have an intrauterine device (IUD). In this case, the client's symptoms are classic for ectopic pregnancy, where the fertilized egg implants outside the uterus, commonly in the fallopian tube. Missed abortion (choice A) refers to a nonviable embryo or fetus in the uterus, which is not consistent with the client's presentation. Severe preeclampsia (choice C) is characterized by hypertension and proteinuria, not the symptoms described. Hydatidiform mole (choice D) presents with vaginal bleeding but typically lacks abdominal pain and is not related to the presence of an IUD.

3. When reinforcing discharge teaching to the parents of a newborn regarding circumcision care, which statement made by a parent indicates an understanding of the teaching?

• A. The circumcision will heal within a couple of days.
• B. I should not remove the yellow mucus that will form.
• C. I will clean the penis with each diaper change.
• D. I will give him a tub bath within a couple of days.

Correct answer: C

Rationale: The correct answer is C because cleaning the penis with each diaper change is essential for preventing infection and promoting healing after circumcision. This practice helps maintain good hygiene and reduces the risk of complications. Removing the yellow mucus or giving a tub bath too soon can interfere with the healing process and increase the likelihood of infection. Choice A is incorrect because circumcision healing usually takes about a week or more, not just a couple of days. Choice B is incorrect because parents should gently clean the area, including removing any discharge or debris as part of proper care. Choice D is incorrect because tub baths should be avoided until the circumcision is fully healed to prevent infection.

4. During ambulation to the bathroom, a postpartum client experiences a gush of dark red blood that soon stops. On data collection, a nurse finds the uterus to be firm, midline, and at the level of the umbilicus. Which of the following findings should the nurse interpret this data as being?

• A. Evidence of a possible vaginal hematoma
• B. An indication of a cervical or perineal laceration
• C. A normal postpartum discharge of lochia
• D. Abnormally excessive lochia rubra flow

Correct answer: C

Rationale: The nurse should interpret this data as a normal postpartum discharge of lochia. Lochia is the normal vaginal discharge after childbirth, and the gush of dark red blood upon ambulation is typical due to the pooling of blood in the vagina when lying down, which is then released upon standing. The firm, midline uterus at the level of the umbilicus indicates normal involution of the uterus postpartum. Therefore, this scenario is consistent with the expected postpartum physiological changes rather than complications like hematoma, lacerations, or abnormal excessive bleeding. Choices A, B, and D are incorrect because the described findings are more indicative of normal postpartum processes rather than complications such as vaginal hematoma, lacerations, or excessive bleeding.

5. A healthcare provider is assessing a newborn 1 hr after birth. Which of the following respiratory rates is within the expected reference range for a newborn?

• A. 22/min
• B. 48/min
• C. 100/min
• D. 110/min

Correct answer: B

Rationale: The expected respiratory rate for a newborn is between 30 to 60 breaths per minute. A rate of 48 breaths per minute falls within this range, indicating normal respiratory function for a newborn. Choice A (22/min) is below the expected range, Choices C (100/min) and D (110/min) are above the expected range for a newborn's respiratory rate.

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