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 who underwent an amniotomy is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

• A. Maintain the client in the lithotomy position.
• B. Perform vaginal examinations frequently.
• C. Remind the client to bear down with each contraction.
• D. Encourage the client to empty her bladder every 2 hours.

Correct answer: D

Rationale: Encouraging the client to empty her bladder every 2 hours is essential during labor to prevent bladder distention, which can hinder labor progress and cause discomfort. A distended bladder can also lead to potential complications such as uterine atony or increased risk of infection. Choice A is incorrect as maintaining the client in the lithotomy position is not necessary during the active phase of the first stage of labor and may not be comfortable for the client. Choice B is incorrect because performing vaginal examinations frequently can increase the risk of introducing infection and disrupt the natural progress of labor. Choice C is incorrect as bearing down with each contraction is typically reserved for the second stage of labor when the cervix is fully dilated, not during the active phase of the first stage.

3. During the third trimester of pregnancy, which of the following findings should a nurse recognize as an expected physiologic change?

• A. Gradual lordosis
• B. Increased abdominal muscle tone
• C. Posterior neck flexion
• D. Decreased mobility of pelvic joints

Correct answer: A

Rationale: During pregnancy, gradual lordosis is a common adaptation to the growing fetus. Lordosis refers to an increased lumbar curve in the spine, which helps to shift the center of gravity forward, supporting the enlarging uterus. This change is necessary to maintain balance and reduce strain on the back muscles as the pregnancy progresses. Increased abdominal muscle tone, posterior neck flexion, and decreased mobility of pelvic joints are not typical physiological changes during pregnancy. Increased abdominal muscle tone is not expected as the abdominal muscles tend to stretch and separate to accommodate the growing fetus. Posterior neck flexion is not a common finding and decreased mobility of pelvic joints is not an expected change and can cause discomfort.

4. A nurse is caring for a client who is at 40 weeks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate?

• A. Epidural analgesia
• B. Naloxone hydrochloride
• C. Attention-focusing
• D. Pudendal nerve block

Correct answer: C

Rationale: Attention-focusing and distraction techniques are types of nonpharmacological care that are effective in relieving labor pain.

5. 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.

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