Nursing Elites

1. A young woman who underwent a liver transplant one year ago tells the clinic nurse that she would like to start a family. How should the nurse intervene?

• A. Provide information about the high-risk nature of her pregnancy.
• B. Gently remind the client that anti-rejection drugs can cause sterility.
• C. Explain the benefits of waiting for a five-year post-transplant period.
• D. Determine if the client is considering options for adopting a child.

Correct answer: A

Rationale: Post-liver transplant pregnancy is high-risk due to potential complications associated with immunosuppressive therapy and the transplanted organ's health. Providing information about the risks involved allows the client to make an informed decision regarding family planning.

2. 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.

3. A primipara patient asks what is the best pet to have at home to share time with. Which pet is not recommended?

• A. Dog
• B. Cat
• C. Bird
• D. Fish

Correct answer: C

Rationale: Birds are not recommended as pets for a primipara patient due to potential health risks associated with bird droppings, feathers, and dander. These factors may pose a risk to the newborn's health and the mother's well-being. Additionally, some birds can be loud, which may disrupt the baby's sleep patterns. Therefore, it is advisable for primipara patients to consider pets like dogs, cats, or fish as they generally have lower associated risks in a household with a newborn. Dogs, cats, and fish are relatively safer options compared to birds for primipara patients due to their lower risk of transmitting infections, allergens, or causing disturbances that could affect the newborn or the mother.

4. Which physical assessment data should the nurse consider a normal finding for a primigravida client who is 12 hours postpartum?

• A. Unilateral lower leg pain.
• B. Saturating two perineal pads per hour.
• C. Pulse rate of 56 bpm.
• D. Soft, spongy fundus.

Correct answer: C

Rationale: A pulse rate of 56 bpm is a normal finding for a primigravida client who is 12 hours postpartum. Bradycardia (pulse rate 50-70 bpm) can be a normal postpartum occurrence due to increased stroke volume and decreased cardiac output after delivery. Unilateral lower leg pain and saturating two perineal pads per hour are not normal findings and require further assessment. A soft, spongy fundus could indicate uterine atony, which is abnormal postpartum.

5. The healthcare provider is preparing to administer methylergonovine maleate (Methergine) to a postpartum client. Based on what assessment finding should the healthcare provider withhold the drug?

• A. Respiratory rate of 22 breaths/min
• B. A large amount of lochia rubra
• C. Blood pressure 149/90
• D. Positive Homan’s sign

Correct answer: C

Rationale: A blood pressure of 149/90 is an indication to withhold Methergine due to its potential to further increase blood pressure. Methergine is a medication that can cause vasoconstriction, leading to elevated blood pressure. In this case, administering Methergine could exacerbate the elevated blood pressure, posing a risk to the patient. Therefore, it is crucial to withhold the medication in the presence of hypertension to prevent adverse effects. The other options are not directly related to the administration of Methergine. A respiratory rate of 22 breaths/min is within the normal range. A large amount of lochia rubra may indicate normal postpartum bleeding. A positive Homan’s sign is associated with deep vein thrombosis, which is not a contraindication for administering Methergine.

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