Nursing Elites

1. A woman who delivered a 9-pound baby via cesarean section under spinal anesthesia is recovering in the post-anesthesia care unit. Her fundus is firm at the umbilicus, and a continuous trickle of bright red blood with no clots is observed by the nurse. Which action should the nurse implement?

• A. Assess her blood pressure.
• B. Apply an ice pack to the perineum.
• C. Allow the infant to breastfeed.
• D. Massage the fundus vigorously.

Correct answer: A

Rationale: In this situation, continuous bleeding despite a firm fundus suggests a possible laceration. The appropriate action for the nurse to take is to assess the woman's blood pressure. This helps determine the severity of blood loss and guides further interventions, such as identifying the need for additional assessments or interventions to control bleeding. Applying an ice pack to the perineum (choice B) would not address the ongoing bleeding issue. Allowing the infant to breastfeed (choice C) may not be safe if there is significant bleeding. Massaging the fundus vigorously (choice D) is contraindicated when there is continuous bleeding as it can worsen the bleeding or cause further harm.

2. The client at 10 weeks' gestation is palpated with the fundus at 3 fingerbreadths above the pubic symphysis. The client reports nausea, vomiting, and scant dark brown vaginal discharge. What action should the nurse take?

• A. Collect a urine sample for urinalysis.
• B. Measure vital signs.
• C. Recommend bed rest.
• D. Obtain human chorionic gonadotropin levels.

Correct answer: D

Rationale: In a pregnant client with a fundal height greater than expected at 10 weeks and experiencing scant dark brown vaginal discharge, there is a concern for a molar pregnancy. Assessing human chorionic gonadotropin (hCG) levels is crucial in this situation to confirm or rule out this condition.

3. The healthcare provider is reviewing the serum laboratory findings for a 5-day-old infant with congenital adrenal hyperplasia. Which laboratory result should be reported to the healthcare provider immediately?

• A. Bilirubin of 1.5 mg/dl.
• B. Glucose of 80 mg/dl.
• C. Potassium of 4.5 mEq/L.
• D. Sodium of 119 mEq/L.

Correct answer: D

Rationale: Low sodium levels in congenital adrenal hyperplasia can indicate salt-wasting crisis, which is a life-threatening emergency requiring immediate medical attention. Monitoring sodium levels is crucial to prevent complications such as dehydration and shock in these patients.

4. The LPN/LVN is preparing a client with a term pregnancy who is in active labor for an amniotomy. What equipment should the nurse have available at the client's bedside?

• A. Litmus paper.
• B. Fetal scalp electrode.
• C. A sterile glove.
• D. Needle and Thread

Correct answer: C

Rationale: For performing an amniotomy, the nurse should have a sterile glove to maintain asepsis and an amniotic hook to rupture the amniotic sac. Litmus paper is not required for this procedure, and a fetal scalp electrode is used for fetal monitoring, not for an amniotomy.

5. When counseling a couple seeking information about conceiving, the LPN/LVN should know that ovulation usually occurs

• A. two weeks before menstruation.
• B. immediately after menstruation.
• C. immediately before menstruation.
• D. three weeks before menstruation.

Correct answer: A

Rationale: Ovulation typically occurs about 14 days before the start of the next menstrual period. This timing allows for the released egg to travel down the fallopian tube where it may be fertilized by sperm, leading to conception. Understanding the timing of ovulation is crucial for couples trying to conceive to increase their chances of success.

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