Nursing Elites

1. A client with pregestational type 1 diabetes mellitus is being taught by a nurse about management during pregnancy. Which of the following statements by the client indicates an understanding of the teaching?

• A. I should aim to maintain my fasting blood glucose between 100 and 120.
• B. I should engage in moderate exercise for 30 minutes if my blood glucose is 250 or higher.
• C. I will continue taking my insulin if I experience nausea and vomiting.
• D. I will avoid exercise if my blood glucose exceeds 250.

Correct answer: C

Rationale: The correct answer is C. It is essential for a client with pregestational type 1 diabetes mellitus to continue taking insulin as prescribed even if they experience nausea and vomiting. This is crucial to prevent fluctuations in blood glucose levels that could lead to serious complications. Choice A is incorrect because the fasting blood glucose target for pregnant women with diabetes is usually lower. Choice B is incorrect as engaging in exercise when blood glucose is high is not recommended. Choice D is incorrect as avoiding exercise is not the appropriate approach when blood glucose levels are elevated.

2. A newborn was transferred to the nursery 30 min after delivery. What should the nurse do first?

• A. Confirm the newborn's identification.
• B. Verify the newborn's identification.
• C. Administer vitamin K to the newborn.
• D. Determine obstetrical risk factors.

Correct answer: B

Rationale: When a newborn is transferred to the nursery, the first action the nurse should take is to verify the newborn's identification. This step is crucial for ensuring the correct care is provided to the right newborn, promoting patient safety and preventing errors. Administering vitamin K (Choice C) is important but should not be the first action. Determining obstetrical risk factors (Choice D) is not the priority when the newborn is transferred to the nursery. Confirming (Choice A) and verifying (Choice B) have similar meanings, but 'verify' is a more appropriate term in this context.

3. A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea, vomiting, and scant, prune-colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect?

• A. Hyperemesis gravidarum
• B. Threatened abortion
• C. Hydatidiform mole
• D. Preterm labor

Correct answer: C

Rationale: In this scenario, the symptoms of continued nausea, vomiting, scant prune-colored discharge, and a fundal height larger than expected at 4 months of gestation suggest a possible hydatidiform mole. Hyperemesis gravidarum (choice A) typically presents with severe nausea, vomiting, weight loss, and electrolyte imbalances. Threatened abortion (choice B) is characterized by vaginal bleeding with or without cramping but does not typically present with prune-colored discharge. Preterm labor (choice D) manifests with regular uterine contractions leading to cervical changes and can occur later in pregnancy.

4. A client who is at 22 weeks of gestation reports concern about the blotchy hyperpigmentation on her forehead. Which of the following actions should the nurse take?

• A. Tell the client to follow up with a dermatologist.
• B. Explain to the client this is an expected occurrence.
• C. Instruct the client to increase her intake of vitamin D.
• D. Inform the client she might have an allergy to her skin care products.

Correct answer: B

Rationale: Chloasma, also known as the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead. It is most common in dark-skinned women and is caused by an increase in melanotropin during pregnancy. This condition typically appears after 16 weeks of gestation and gradually increases until delivery for 50 to 70% of women. The nurse should reassure the client that this is an expected occurrence, which usually fades after delivery. Therefore, explaining to the client that this is an expected occurrence is the appropriate action in this situation. Options A, C, and D are incorrect because chloasma is a common skin change during pregnancy and does not require a referral to a dermatologist, an increase in vitamin D intake, or suspicion of an allergy to skin care products.

5. A client in active labor at 39 weeks of gestation is receiving continuous IV oxytocin and has early decelerations in the FHR on the monitor tracing. What action should the nurse take?

• A. Discontinue the oxytocin infusion.
• B. Continue monitoring the client.
• C. Request that the provider assess the client.
• D. Increase the infusion rate of the maintenance IV fluid.

Correct answer: B

Rationale: Early decelerations in the FHR are benign and are typically caused by fetal head compression during contractions. In this case, with the client at 39 weeks of gestation and on oxytocin, it is important for the nurse to continue monitoring the client. Early decelerations do not require intervention as they are a normal response to certain stimuli and do not indicate fetal distress. Discontinuing the oxytocin infusion (Choice A) is not necessary as early decelerations are not related to oxytocin administration. Requesting the provider to assess the client (Choice C) is not needed for early decelerations as they are a normal finding. Increasing the infusion rate of the maintenance IV fluid (Choice D) is not indicated and would not address the early decelerations. Therefore, the appropriate action is to continue monitoring the client and reassess as needed.

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