Nursing Elites

1. A client is being discharged after childbirth. At 4 weeks postpartum, the client should contact the provider for which of the following client findings?

• A. Scant, non-odorous white vaginal discharge
• B. Uterine cramping during breastfeeding
• C. Sore nipple with cracks and fissures
• D. Decreased response with sexual activity

Correct answer: C

Rationale: Sore nipples with cracks and fissures should be reported to the provider as this can indicate improper breastfeeding techniques or infection, which requires medical evaluation and intervention to prevent further complications such as mastitis or decreased milk supply. Scant, non-odorous white vaginal discharge is a normal finding postpartum. Uterine cramping during breastfeeding is also common due to oxytocin release. Decreased response with sexual activity may be expected at 4 weeks postpartum due to hormonal changes and fatigue, but it is not typically a concern that needs immediate medical attention.

2. When discussing intermittent fetal heart monitoring with a newly licensed nurse, which statement should a nurse include?

• A. Count the fetal heart rate for 15 seconds to determine the baseline.
• B. Auscultate the fetal heart rate every 5 minutes during the active phase of the first stage of labor.
• C. Count the fetal heart rate after a contraction to determine baseline changes.
• D. Auscultate the fetal heart rate every 30 minutes during the second stage of labor.

Correct answer: C

Rationale: When discussing intermittent fetal heart monitoring, it is crucial to count the fetal heart rate after a contraction to determine baseline changes. This practice allows for the assessment of variations in the fetal heart rate pattern associated with uterine contractions. Monitoring the fetal heart rate after contractions provides valuable insights into fetal well-being and potential distress. Option A is incorrect because determining the baseline involves assessing the fetal heart rate over a more extended period. Option B is incorrect as auscultation every 5 minutes during the active phase of the first stage of labor is too frequent for intermittent monitoring. Option D is incorrect as auscultating the fetal heart rate every 30 minutes during the second stage of labor is too infrequent for proper monitoring of fetal well-being.

3. A healthcare professional is assessing a late preterm newborn. Which of the following clinical manifestations is an indication of hypoglycemia?

• A. Hypertonia
• B. Increased feeding
• C. Hyperthermia
• D. Respiratory distress

Correct answer: D

Rationale: The correct answer is D, respiratory distress, as it is a clinical manifestation of hypoglycemia in newborns. Other signs of hypoglycemia include an abnormal cry, jitteriness, lethargy, poor feeding, apnea, and seizures. Hypertonia, increased feeding, and hyperthermia are not typically associated with hypoglycemia in newborns. Hypertonia is more indicative of neurological issues, increased feeding is not a common sign of hypoglycemia, and hyperthermia is not a typical symptom of low blood sugar.

4. A healthcare professional is assessing a newborn immediately following a scheduled cesarean delivery. Which of the following assessments is the healthcare professional's priority?

• A. Respiratory distress
• B. Hypothermia
• C. Accidental lacerations
• D. Acrocyanosis

Correct answer: A

Rationale: The correct answer is A: Respiratory distress. Assessing for respiratory distress is the priority when evaluating a newborn after a cesarean delivery. Newborns born via cesarean section are at higher risk for respiratory complications, making it crucial to monitor their breathing and ensure proper oxygenation immediately after birth. Choice B, hypothermia, is important too but assessing breathing takes precedence to ensure adequate oxygen supply. Choices C and D, accidental lacerations and acrocyanosis, are not the immediate priorities following a cesarean delivery.

5. A client is reinforcing discharge teaching with a client who has premature rupture of membranes at 26 weeks of gestation. Which of the following instructions should the client include?

• A. Use a condom with sexual intercourse
• B. Avoid bubble bath solution when taking a tub bath
• C. Wipe from front to back when performing perineal hygiene
• D. Keep a daily record of fetal kick counts

Correct answer: D

Rationale: Keeping a daily record of fetal kick counts is crucial for clients with premature rupture of membranes at 26 weeks of gestation as it helps monitor fetal well-being. This activity enables the client to assess the frequency and strength of fetal movements, which can provide important information about the fetus' health and development. Other options such as using a condom with sexual intercourse, avoiding bubble bath solution, and wiping from front to back are important for general perinatal care but are not specifically related to managing premature rupture of membranes.

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