Nursing Elites

1. A client who is 3 days postpartum is receiving education on effective breastfeeding. Which of the following information should the nurse include?

• A. Your milk will replace colostrum in about 10 days.
• B. Your breasts should feel firm after breastfeeding.
• C. Your newborn should urinate at least 10 times per day.
• D. Your newborn should appear content after each feeding.

Correct answer: D

Rationale: The correct answer is D. The nurse should inform the client that a baby who is sated will appear content after feedings. This indicates that the baby is effectively emptying the breasts during feedings. Choices A, B, and C are incorrect because: A) Breast milk replaces colostrum within a few days, not 10 days. B) Breasts feeling firm after breastfeeding may indicate engorgement or plugged ducts, not necessarily effective breastfeeding. C) While the frequency of urination is important, it is not directly related to effective breastfeeding.

2. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

• A. Late decelerations
• B. Moderate variability of the FHR
• C. Cessation of uterine dilation
• D. Prolonged active phase of labor

Correct answer: A

Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.

3. A client at 38 weeks of gestation with a diagnosis of preeclampsia has the following findings. Which of the following should the nurse identify as inconsistent with preeclampsia?

• A. 1+ pitting sacral edema
• B. 3+ protein in the urine
• C. Blood pressure 148/98 mm Hg
• D. Deep tendon reflexes of +1

Correct answer: D

Rationale: Deep tendon reflexes of +1 are inconsistent with preeclampsia. Preeclampsia typically presents with hyperreflexia, not diminished reflexes. Diminished reflexes may indicate other neurological conditions, thus making this finding inconsistent with preeclampsia. Choices A, B, and C are consistent with preeclampsia. Pitting sacral edema, protein in the urine, and elevated blood pressure are common findings in preeclampsia due to fluid retention, kidney involvement, and hypertension associated with the condition.

4. A healthcare provider is assessing fetal heart tones for a pregnant client. The provider has determined the fetal position as left occipital anterior. To which of the following areas of the client's abdomen should the provider apply the ultrasound transducer to assess the point of maximum intensity of the fetal heart?

• A. Left upper quadrant
• B. Right upper quadrant
• C. Left lower quadrant
• D. Right lower quadrant

Correct answer: C

Rationale: When the fetal position is left occipital anterior, the point of maximum intensity of the fetal heart is best heard in the left lower quadrant of the client's abdomen. Placing the ultrasound transducer in the left lower quadrant allows for optimal detection of fetal heart tones in this specific fetal position. Choice A (Left upper quadrant) is incorrect as it is not where the fetal heart tones are best heard in this scenario. Choice B (Right upper quadrant) is also incorrect as it is not the recommended area for assessing fetal heart tones in a left occipital anterior position. Choice D (Right lower quadrant) is incorrect as the focus should be on the left side due to the fetal position mentioned.

5. A client with a BMI of 26.5 is seeking advice on weight gain during pregnancy at the first prenatal visit. Which of the following responses should the nurse provide?

• A. It would be best if you gained about 11 to 20 pounds.
• B. The recommendation for you is about 15 to 25 pounds.
• C. A gain of about 25 to 35 pounds is recommended for you.
• D. A gain of about 1 pound per week is the best pattern for you.

Correct answer: B

Rationale: For a client with a BMI of 26.5 (overweight), the recommended weight gain during pregnancy is 15 to 25 pounds. This range helps promote a healthy pregnancy outcome and reduces the risk of complications associated with excessive weight gain. Option A suggests a lower weight gain range, which may not be adequate for a client with a BMI of 26.5. Option C indicates a higher weight gain range, which could lead to complications for an overweight individual. Option D provides a general guideline for weight gain without considering the client's BMI, which is not personalized advice. Therefore, the most appropriate response is option B, offering a suitable weight gain recommendation for the client's BMI to support a healthy pregnancy journey.

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