Nursing Elites

1. A perinatal nurse is caring for a woman in the immediate postpartum period. Assessment reveals that the client is experiencing profuse bleeding. What is the most likely cause of this bleeding?

• A. Uterine atony.
• B. Uterine inversion.
• C. Vaginal hematoma.
• D. Vaginal laceration.

Correct answer: A

Rationale: Uterine atony is significant hypotonia of the uterus and is the leading cause of postpartum hemorrhage. It results in the inability of the uterus to contract effectively after delivery, leading to excessive bleeding. Uterine inversion is a rare but serious complication that involves the turning inside out of the uterus, leading to hemorrhage, but it is not the most likely cause of profuse bleeding in this scenario. Vaginal hematoma may cause bleeding but is typically associated with pain as a primary symptom rather than profuse bleeding. Vaginal lacerations can cause bleeding, but in the presence of a firm, contracted uterine fundus, uterine atony is a more likely cause of ongoing profuse bleeding in the postpartum period.

2. A newborn is 1 hour old with a respiratory rate of 50/min, a heart rate of 130/min, and an axillary temperature of 36.1°C (97°F). Which of the following actions should be taken?

• A. Give the newborn a warm bath.
• B. Apply a cap to the newborn's head.
• C. Reposition the newborn.
• D. Obtain an oxygen saturation level.

Correct answer: B

Rationale: Applying a cap to the newborn's head is the correct action in this scenario. Newborns are at risk of heat loss due to their high surface area to volume ratio, and maintaining their body temperature is crucial to prevent hypothermia. Giving a warm bath can further increase heat loss and is not recommended. Repositioning the newborn may not address the primary concern of temperature regulation. While monitoring oxygen saturation is important, addressing thermal regulation takes precedence in this situation.

3. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

• A. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
• B. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
• C. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
• D. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Correct answer: B

Rationale: Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.

4. A client at 37 weeks gestation presents to labor and delivery with contractions every two minutes. The nurse observes several shallow small vesicles on her pubis, labia, and perineum. The nurse should recognize the client is exhibiting symptoms of which condition?

• A. Genital Warts
• B. Syphilis
• C. Herpes Simplex Virus
• D. German Measles

Correct answer: C

Rationale: The correct answer is C: Herpes Simplex Virus (HSV). HSV can present with small vesicles on the genital area, and it is a concern during labor due to the risk of transmission to the newborn. Genital warts (Choice A) are caused by the human papillomavirus (HPV) and typically present as flesh-colored growths, not vesicles. Syphilis (Choice B) manifests as painless sores and can have systemic effects but does not typically present with vesicles. German measles (Choice D), also known as Rubella, is a viral illness characterized by a red rash, fever, and lymphadenopathy, not vesicles.

5. Once the testes have developed in the embryo, they begin to produce male sex hormones, or _____.

• A. androgens
• B. genotypes
• C. blastocysts
• D. teratogens

Correct answer: A

Rationale: Androgens are male sex hormones, such as testosterone, produced by the testes after they have developed in the embryo. Androgens are responsible for the development of male secondary sexual characteristics. Genotypes refer to an individual's genetic makeup, not hormones. Blastocysts are early stage embryos, not male sex hormones. Teratogens are substances that can interfere with fetal development, not male sex hormones produced by the testes.

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