Nursing Elites

1. A woman at 36-weeks' gestation who is Rh negative is admitted to labor and delivery reporting abdominal cramping. She is placed on strict bedrest, and the fetal heart rate and contraction pattern are monitored with an external fetal monitor. The nurse notes a large amount of bright red vaginal bleeding. Which nursing intervention has the highest priority?

• A. Perform a sterile vaginal examination to determine dilatation.
• B. Determine fetal position by performing Leopold maneuvers.
• C. Assess the fetal heart rate and client's contraction pattern.
• D. Confirm Rh and Coombs status for Rho(D) immunoglobulin administration.

Correct answer: C

Rationale: The highest priority nursing intervention in this scenario is to assess the fetal heart rate and the client's contraction pattern. The presence of a large amount of bright red vaginal bleeding in a woman at 36-weeks' gestation who is Rh negative raises concerns about the well-being of the fetus. Monitoring the fetal heart rate and contraction pattern will provide crucial information about fetal status and help determine the appropriate course of action to ensure the safety and health of both the mother and the baby.

2. The nurse is caring for a 5-year-old child with Reye’s syndrome. Which goal of treatment most clearly relates to caring for this child?

• A. Reduce cerebral edema and lower intracranial pressure
• B. Avert hypotension and septic shock
• C. Prevent cardiac arrhythmias and heart failure
• D. Promote kidney perfusion and normal blood pressure

Correct answer: A

Rationale: Reducing cerebral edema and lowering intracranial pressure is the primary goal of treatment for Reye’s syndrome.

3. In assessing a 9-year-old boy admitted to the hospital with possible acute post-streptococcal glomerulonephritis (APSGN), what information is most significant to obtain in his history?

• A. Back pain for a few days
• B. A history of hypertension
• C. A sore throat last week
• D. Diuresis during the nights

Correct answer: C

Rationale: A recent sore throat is most significant in this case as it could indicate a preceding streptococcal infection, which is a crucial factor in diagnosing APSGN. Streptococcal infection often precedes APSGN, and recognizing this history is essential for appropriate management and treatment. Choices A, B, and D are less relevant in the context of APSGN. Back pain and diuresis are symptoms that may not directly correlate with APSGN, while a history of hypertension, although important in general health assessment, is not as specific to the current scenario compared to a recent sore throat.

4. A child with ADHD needs help with homework. What should the nurse encourage the parents to do?

• A. Encourage the parents to help the child with homework.
• B. Do the homework for the child.
• C. Set a regular homework schedule.
• D. Provide a quiet environment for homework.

Correct answer: A

Rationale: Encouraging parents to help the child with homework is the most appropriate course of action. By assisting the child, parents can provide necessary support and guidance without taking over the task entirely. This approach fosters independence and helps the child develop academic skills. Option B, doing the homework for the child, is counterproductive as it does not empower the child to learn and grow independently. Option C, setting a regular homework schedule, is important but does not address the immediate need for assistance. Option D, providing a quiet environment for homework, is helpful but does not directly involve parents in supporting the child's academic progress.

5. The healthcare provider prescribes terbutaline (Brethine) for a client in preterm labor. Before initiating this prescription, it is most important for the LPN/LVN to assess the client for which condition?

• A. Gestational diabetes.
• B. Elevated blood pressure.
• C. Urinary tract infection.
• D. Swelling in lower extremities.

Correct answer: A

Rationale: The correct answer is A: Gestational diabetes. Terbutaline (Brethine) is known to cause hyperglycemia, so it is crucial to assess for gestational diabetes before administering it. Assessing for elevated blood pressure (choice B), urinary tract infection (choice C), or swelling in lower extremities (choice D) is not directly related to the potential side effect of terbutaline in causing hyperglycemia.

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