Nursing Elites

1. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?

• A. Estriol is not found in maternal saliva.
• B. Irregular, mild uterine contractions occur every 12 to 15 minutes.
• C. Fetal fibronectin is present in vaginal secretions.
• D. The cervix is effacing and dilated to 2 cm.

Correct answer: D

Rationale: The correct answer is D. Cervical changes such as effacement and dilation to 2 cm are strong indicators of imminent preterm labor. These changes, combined with regular contractions, can signify labor at any gestation. Estriol can be detected in maternal plasma as early as 9 weeks of gestation. Levels of salivary estriol have been linked to preterm birth. Irregular, mild contractions occurring every 12 to 15 minutes without cervical change are generally not concerning. While the presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation may predict preterm labor, its predictive value is limited (20%-40%). Therefore, cervical changes provide more reliable information regarding the risk of preterm labor.

2. What additional assessment is required for the postoperative care of a pregnant woman who undergoes abdominal surgery for appendicitis?

• A. Intake and output (I&O) and intravenous (IV) site.
• B. Signs and symptoms of infection.
• C. Vital signs and incision.
• D. Fetal heart rate (FHR) and uterine activity.

Correct answer: D

Rationale: The correct additional assessment for postoperative care of a pregnant woman requiring abdominal surgery for appendicitis is monitoring the fetal heart rate (FHR) and uterine activity. This is crucial due to the presence of the fetus. Continuous fetal and uterine monitoring should be prioritized to ensure the well-being of both the mother and the baby. While assessing I&O levels and the IV site are common postoperative care procedures, they are not specific to the unique needs of a pregnant woman. Evaluating for signs and symptoms of infection is important for any postoperative patient but is not the additional assessment required specifically for a pregnant woman in this scenario. Routine vital signs and incision evaluation are standard components of postoperative care but do not address the specific needs related to the fetus and the uterus in this case.

3. A nurse on the labor and delivery unit is assessing four clients. Which of the following clients is a candidate for an induction of labor with misoprostol?

• A. A client who has active genital herpes
• B. A client who has gestational diabetes mellitus
• C. A client who has a previous uterine incision
• D. A client who has placenta previa

Correct answer: B

Rationale: Misoprostol can be used for induction in clients with gestational diabetes mellitus. Choice A, a client with active genital herpes, is not a candidate for misoprostol induction due to the risk of viral shedding and transmission. Choice C, a client with a previous uterine incision, may be at risk for uterine rupture with misoprostol use. Choice D, a client with placenta previa, is not an appropriate candidate for misoprostol induction due to the risk of increased bleeding associated with the condition.

4. _________ are problems that stem from the interaction of heredity and environmental factors.

• A. Multifactorial problems
• B. Cognitive problems
• C. Horizon problems
• D. Coronal problems

Correct answer: A

Rationale: Multifactorial problems are conditions that result from the interplay of genetic and environmental factors. These conditions, such as diabetes or heart disease, are not solely determined by genetics or environment but are influenced by a combination of both factors. Choice B, cognitive problems, refers to difficulties related to thinking, learning, and memory and are not specifically linked to genetic and environmental interactions. Choices C and D, horizon problems and coronal problems, are nonsensical terms and do not relate to the interaction of heredity and environmental factors.

5. A client has active genital herpes simplex virus type 2. Which of the following medications should the nurse plan to administer?

• A. Metronidazole
• B. Penicillin
• C. Acyclovir
• D. Gentamicin

Correct answer: C

Rationale: Acyclovir is the antiviral medication specifically used to treat herpes simplex virus infections, including genital herpes caused by herpes simplex virus type 2. Metronidazole (Choice A) is an antibiotic used for different types of infections, but not for viral infections like herpes. Penicillin (Choice B) is an antibiotic effective against bacterial infections, not viruses like herpes. Gentamicin (Choice D) is an antibiotic mainly used to treat bacterial infections, not viral infections like herpes.

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