Nursing Elites

1. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?

• A. Perform a guaiac test and record the results.
• B. Recognize the finding as abnormal and report it to the primary health care provider.
• C. Recognize the finding as a normal result of iron therapy.
• D. Check the woman’s next stool to validate the observation.

Correct answer: C

Rationale: The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. Dark stools are a known, expected result of iron supplementation and are not indicative of a complication unless other symptoms of GI bleeding are present. A guaiac test would be necessary if there were concerns about gastrointestinal bleeding. Recognizing dark stools as a consequence of iron therapy is an essential nursing assessment skill and does not require immediate reporting. Checking the next stool to confirm the observation is unnecessary as the presence of dark stools in this context is already an expected outcome of iron supplementation.

2. Which neonatal complications are associated with hypertension in the mother?

• A. Intrauterine growth restriction (IUGR) and prematurity.
• B. Seizures and cerebral hemorrhage.
• C. Hepatic or renal dysfunction.
• D. Placental abruption and DIC.

Correct answer: A

Rationale: Neonatal complications associated with maternal hypertension are primarily due to placental insufficiency. The correct answer is A, which includes Intrauterine Growth Restriction (IUGR) and prematurity. These complications arise from inadequate blood flow to the fetus, leading to growth restriction and premature birth. Choices B, seizures, and cerebral hemorrhage are more commonly maternal complications rather than neonatal ones. Choice C, hepatic or renal dysfunction, pertains to maternal complications of hypertensive disorders in pregnancy, not neonatal issues. Choice D, placental abruption, and Disseminated Intravascular Coagulation (DIC) are conditions linked to maternal morbidity and mortality, not neonatal complications.

3. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?

• A. Temperature 37.9°C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg.
• B. Temperature 37.4°C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg.
• C. Temperature 38°C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg.
• D. Temperature 36.8°C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg.

Correct answer: A

Rationale: An estimated blood loss (EBL) of 1500 ml following a vaginal birth is significant and can lead to hypovolemia. The vital signs provided in option A (Temperature 37.9°C, heart rate 120 bpm, respirations 20 breaths per minute, and blood pressure 90/50 mm Hg) indicate tachycardia and hypotension, which are concerning signs of hypovolemia due to excessive blood loss. Tachycardia is the body's compensatory mechanism to maintain cardiac output in response to decreased blood volume, and hypotension indicates inadequate perfusion. Options B, C, and D do not exhibit the same level of concern for hypovolemia. Option B shows tachypnea, which can be a result of pain or anxiety postpartum. Option C and D have vital signs within normal limits, which are not indicative of the body's response to significant blood loss.

4. A new mother who is a lacto-ovo vegetarian plans to breastfeed her infant. Which information should the nurse provide prior to discharge?

• A. Continue prenatal vitamins with B12 while breastfeeding
• B. Avoid using Lanolin-based nipple cream or ointment
• C. Offer iron-fortified supplemental formula daily
• D. Weigh the baby weekly to evaluate the newborn's growth

Correct answer: A

Rationale: The correct answer is A: 'Continue prenatal vitamins with B12 while breastfeeding.' Vitamin B12 is crucial for lacto-ovo vegetarian mothers to prevent deficiencies in both the mother and the infant. Choice B is incorrect as Lanolin-based nipple cream is safe for use during breastfeeding. Choice C is not necessary unless there are specific indications for iron supplementation. Choice D, weighing the baby weekly, is important for monitoring growth but not specifically related to the mother's diet.

5. When children who are reared by adoptive parents are nonetheless more similar to their natural parents in a trait, it can be concluded that:

• A. the genetic characteristics of the children change over time.
• B. heredity is solely responsible for how a child grows.
• C. the environment is solely responsible for the development of those characteristics.
• D. genetics play a role in the development of those characteristics.

Correct answer: D

Rationale: When children exhibit traits that are more similar to their biological parents than their adoptive parents, it indicates a strong genetic influence on those traits. This similarity suggests that genetics play a significant role in the development of the observed characteristics. Choice A is incorrect because genetic characteristics do not change over time in this context. Choice B is incorrect as it implies that heredity is the only factor, disregarding the impact of the environment. Choice C is also incorrect as it suggests that only the environment influences trait development, overlooking the genetic contribution.

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