Nursing Elites

1. A client with hyperemesis gravidarum is receiving dietary teaching. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will eat foods that appeal to my taste instead of trying to balance my meals.
• B. I will avoid having a snack at bedtime.
• C. I will have 8 ounces of hot tea with each meal.
• D. I will pair my sweets with a starch instead of eating them alone.

Correct answer: A

Rationale: In hyperemesis gravidarum, where there is severe nausea and vomiting during pregnancy, it is essential for the client to eat foods that appeal to their taste to prevent further nausea. Balancing meals may not be a priority initially if the client is struggling to keep any food down. Choice B is unrelated to managing hyperemesis gravidarum. Choice C, having hot tea with each meal, may not necessarily address the issue of taste preferences. Choice D, pairing sweets with a starch, is not as relevant as choosing foods appealing to taste for managing hyperemesis gravidarum.

2. During an assessment, a client at 26 weeks of gestation presents with which of the following clinical manifestations that should be reported to the provider?

• A. Leukorrhea
• B. Supine hypotension
• C. Periodic numbness of the fingers
• D. Decreased urine output

Correct answer: D

Rationale: During pregnancy, decreased urine output can be indicative of decreased renal perfusion and impaired fetal well-being. It can also be a sign of preeclampsia when associated with symptoms like increased blood pressure, proteinuria, and decreased fetal activity. Therefore, the nurse should promptly report this finding to the healthcare provider for further evaluation and management. Leukorrhea is a common finding in pregnancy and not typically concerning. Supine hypotension and periodic numbness of the fingers can be managed by changing positions or adjusting posture and are not as urgent as decreased urine output in this context.

3. A client who is 2 hours postpartum is in the taking-hold phase. Which intervention should the nurse plan to implement during this phase of postpartum behavioral adjustment?

• A. Discuss contraceptive options with the client and her partner.
• B. Repeat information to ensure client understanding.
• C. Listen to the client and her partner as they reflect upon the birth experience.
• D. Demonstrate to the client how to perform a newborn bath.

Correct answer: D

Rationale: During the taking-hold phase of postpartum behavioral adjustment, the new mother starts taking a stronger interest in her new role as a mother. This phase involves the mother focusing on the care of her newborn and acquiring parenting skills. Demonstrating how to perform a newborn bath is an appropriate intervention during this phase as it helps the mother actively engage in caring for her baby, which aligns with the developmental tasks of this phase. Choices A, B, and C are incorrect as they do not specifically address the mother's need to actively engage in caring for her newborn during the taking-hold phase. Discussing contraceptive options, repeating information, and listening to reflections on the birth experience are more relevant to other phases of postpartum adjustment.

4. When providing care for a client in preterm labor at 32 weeks of gestation, which medication should the nurse anticipate the provider will prescribe to hasten fetal lung maturity?

• A. Calcium gluconate
• B. Indomethacin
• C. Nifedipine
• D. Betamethasone

Correct answer: D

Rationale: Betamethasone is the correct medication to anticipate the provider prescribing to hasten fetal lung maturity in clients at risk for preterm labor. It is a corticosteroid that helps promote lung maturation in the preterm fetus by stimulating the production of surfactant, which is essential for lung function. This medication is commonly given to pregnant individuals at risk of preterm delivery between 24 and 34 weeks of gestation to reduce the risk of respiratory distress syndrome in the newborn. Calcium gluconate, Indomethacin, and Nifedipine are not used to hasten fetal lung maturity in preterm labor; they serve different purposes in maternal and fetal care.

5. A healthcare professional is assessing four newborns. Which of the following findings should the professional report to the provider?

• A. A newborn who is 26 hours old and has erythema toxicum on their face
• B. A newborn who is 32 hours old and has not passed meconium stool
• C. A newborn who is 12 hours old and has pink-tinged urine
• D. A newborn who is 18 hours old and has an axillary temperature of 37.7° C (99.9° F)

Correct answer: D

Rationale: An axillary temperature greater than 37.5° C (99.5° F) is above the expected reference range for a newborn and can be an indication of sepsis. Therefore, the healthcare professional should report this finding to the provider for further evaluation and management to rule out sepsis. Choices A, B, and C are within the expected range of normal findings for newborns. Erythema toxicum is a common and benign rash in newborns, not requiring immediate reporting. Not passing meconium stool within the first 24-48 hours can be normal, and pink-tinged urine can be due to uric acid crystals excretion, which is also common in newborns.

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