Nursing Elites

1. A nurse is teaching clients in a prenatal class about the importance of taking folic acid during pregnancy. The nurse should instruct the clients to consume an adequate amount of folic acid from various sources to prevent which of the following fetal abnormalities?

• A. Neural tube defect
• B. Trisomy 21
• C. Cleft lip
• D. Atrial septal defect

Correct answer: A

Rationale: The nurse should educate clients that inadequate folic acid intake is associated with an increased risk of neural tube defects in newborns. Consuming an adequate amount of folic acid from sources like fortified cereals, oranges, artichokes, liver, broccoli, and asparagus can help prevent this serious fetal abnormality. Trisomy 21 (Choice B) is caused by an extra chromosome 21 and is not preventable by folic acid intake. Cleft lip (Choice C) and atrial septal defect (Choice D) are not directly linked to folic acid intake during pregnancy.

2. When caring for a client in labor, which of the following infections can be treated during labor or immediately following birth? (Select all that apply)

• A. Gonorrhea
• B. Chlamydia
• C. HIV
• D. All of the Above

Correct answer: D

Rationale: Infections such as gonorrhea, chlamydia, and HIV can be treated during labor or immediately following birth to prevent transmission to the newborn. It is crucial to identify and treat these infections promptly to reduce the risk of vertical transmission to the infant. Therefore, all the given options are correct as they can be treated during labor or immediately following birth to prevent transmission to the newborn. Other choices are incorrect because only gonorrhea, chlamydia, and HIV can be effectively treated during labor or immediately after birth to prevent vertical transmission.

3. 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.

4. A client in the antepartum unit is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

• A. Placenta previa
• B. Prolapsed cord
• C. Incompetent cervix
• D. Abruptio placentae

Correct answer: D

Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall, which can cause continuous abdominal pain and vaginal bleeding. In this scenario, the client's symptoms of sudden abdominal pain and vaginal bleeding are indicative of abruptio placentae, which requires immediate medical attention to prevent potential complications for both the client and the fetus. Placenta previa is characterized by painless vaginal bleeding in the third trimester, not sudden abdominal pain. Prolapsed cord presents with visible umbilical cord protruding from the vagina and is not associated with abruptio placentae symptoms. Incompetent cervix typically manifests as painless cervical dilation in the second trimester, not sudden abdominal pain and bleeding as seen in abruptio placentae.

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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