Nursing Elites

1. A client is receiving postpartum discharge teaching after being vaccinated for varicella due to lack of immunity. Which statement by the client indicates understanding?

• A. I will need a second vaccination at my postpartum visit.
• B. I need a second vaccination at my postpartum visit.
• C. I was given the vaccine to protect myself from varicella.
• D. I will be tested in 3 months to confirm my immunity status.

Correct answer: B

Rationale: The correct answer is B because the client needs a second varicella vaccination at the postpartum visit to ensure immunity. Option A is incorrect as it implies a future need for a second vaccination without a clear action plan. Option C is incorrect as the varicella vaccine is primarily for the client's protection, not others. Option D is not the appropriate action as waiting to be tested for immunity delays the necessary second vaccination.

2. A client in an obstetrical clinic is discussing using an IUD for contraception with a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. An IUD should be replaced annually during a pelvic exam.
• B. I cannot get an IUD until after I've had a child.
• C. I should plan on regaining fertility 5 months after the IUD is removed.
• D. I will check to ensure the strings of the IUD are still present after my periods.

Correct answer: D

Rationale: Checking for the presence of IUD strings after each period is crucial to ensure the IUD is correctly positioned and functioning. This practice helps in confirming the effectiveness of the contraceptive method and timely detection of any displacement or issues with the IUD. Choice A is incorrect as IUDs have varying durations of effectiveness, but they do not need to be replaced annually as a routine. Choice B is incorrect as women can get an IUD even if they haven't had a child. Choice C is incorrect as fertility typically returns shortly after IUD removal, not necessarily after a specific timeframe like 5 months.

3. A newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight should be classified as which of the following?

• A. Low birth weight
• B. Appropriate for gestational age
• C. Small for gestational age
• D. Large for gestational age

Correct answer: B

Rationale: The classification of a newborn as appropriate for gestational age is determined by considering the weight and gestational age. In this case, the newborn's weight falls within the normal range for the gestational age, indicating that the newborn is appropriately sized for the length of time spent in the womb. Choice A, 'Low birth weight,' is incorrect as the newborn's weight is within the normal range. Choice C, 'Small for gestational age,' is incorrect because the newborn's weight is not below the 10th percentile for gestational age. Choice D, 'Large for gestational age,' is incorrect as the newborn's weight is not above the 90th percentile, rather falling within the 60th percentile which is considered normal.

4. A client who is postpartum received methylergonovine. Which of the following findings indicates that the medication was effective?

• A. Increase in blood pressure
• B. Fundus firm to palpation
• C. Increase in lochia
• D. Report of absent breast pain

Correct answer: B

Rationale: Methylergonovine is used to prevent or treat postpartum hemorrhage by contracting the uterus. A firm fundus indicates effective uterine contraction and less bleeding. Therefore, the correct answer is a firm fundus to palpation. The increase in blood pressure (Choice A) is not a typical finding associated with the effectiveness of methylergonovine. Increase in lochia (Choice C) may indicate excessive bleeding rather than the medication's effectiveness. Absence of breast pain (Choice D) is not directly related to the medication's effectiveness in treating postpartum hemorrhage.

5. A client who is at 42 weeks gestation and in labor asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make?

• A. Your baby will have excess baby fat.
• B. Your baby will have flat areola without breast buds.
• C. Your baby's heels will easily move to his ears.
• D. Your baby's skin will have a leathery appearance.

Correct answer: D

Rationale: The correct answer is D: 'Your baby's skin will have a leathery appearance.' Postmature infants, born after 42 weeks of gestation, may have a leathery appearance of the skin due to prolonged exposure to amniotic fluid. This occurs as the protective vernix caseosa is shed, and the skin loses its protective covering, leading to a wrinkled and dry appearance. Choices A, B, and C are incorrect. Excess baby fat is not a typical characteristic of postmature infants. Flat areola without breast buds and the ability of the baby's heels to easily move to his ears are not associated with postmaturity.

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