Nursing Elites

1. An amniocentesis is scheduled for a pregnant client in the third trimester. The nurse informs the client that the most common indication for amniocentesis during the third trimester is for which reason?

• A. Determination of whether alpha-fetoprotein (AFP) is present in the amniotic fluid
• B. Checking the amniotic fluid for intrauterine infection
• C. Determination of fetal lung maturity
• D. Checking the fetal cells for chromosomal abnormalities

Correct answer: C

Rationale: The most common indication for amniocentesis in the third trimester is the determination of fetal lung maturity. This assessment is essential to evaluate the fetus's readiness for extrauterine life. Checking for alpha-fetoprotein (AFP) in the amniotic fluid is more commonly associated with midtrimester amniocentesis to identify chromosomal abnormalities. Assessing for intrauterine infection is not a primary reason for amniocentesis in the third trimester. While checking fetal cells for chromosomal abnormalities is a common indication for midtrimester amniocentesis, it is not the most common indication in the third trimester.

2. While a client is on total parenteral nutrition, which of the following values should the nurse monitor closely?

• A. calcium
• B. magnesium
• C. glucose
• D. cholesterol

Correct answer: C

Rationale: Glucose should be monitored closely when a client is on total parenteral nutrition due to the high glucose concentration in the solutions. Monitoring glucose levels is crucial to prevent complications such as hyperglycemia or hypoglycemia. Calcium and magnesium are usually monitored to assess electrolyte imbalances, while cholesterol levels are not directly impacted by total parenteral nutrition. Therefore, choices A, B, and D are not the primary values that need close monitoring during total parenteral nutrition.

3. The LPN is preparing a client for discharge, and the discharge medications include phenobarbital. Which of these client statements would indicate a need for reinforced teaching about this medication?

• A. "I will need to avoid eating excessive leafy greens."?
• B. "It's best to take this medication with food."?
• C. "I can't wait to get back to my nightly glass of wine."?
• D. "I should try to take this medication at the same time every day."?

Correct answer: C

Rationale: The correct answer is, "I can't wait to get back to my nightly glass of wine,"? as phenobarbital should not be taken with alcohol as it is a barbiturate. Alcohol may increase the sedative effect, posing risks to the patient's safety. Choice A, "I will need to avoid eating excessive leafy greens,"? is unrelated to phenobarbital and not a cause for reinforced teaching. Choice B, "It's best to take this medication with food,"? is a general instruction and not specific to phenobarbital. Choice D, "I should try to take this medication at the same time every day,"? is a common recommendation for medication adherence but does not highlight a specific concern related to phenobarbital.

4. Which of the following physical findings indicates that an 11-12-month-old child is at risk for developmental dysplasia of the hip?

• A. refusal to walk
• B. not pulling to a standing position
• C. negative Trendelenburg sign
• D. negative Ortolani sign

Correct answer: B

Rationale: The correct answer is 'not pulling to a standing position.' An 11-12-month-old child not pulling to a standing position may be at risk for developmental dysplasia of the hip. By this age, children typically pull to a standing position, and failure to do so should raise concerns. Refusal to walk is a broader observation and not specific to hip dysplasia. The Trendelenburg sign indicates weakness of the gluteus medius muscle, not hip dysplasia. The Ortolani sign is used to detect congenital subluxation or dislocation of the hip, which is different from developmental dysplasia of the hip.

5. A nurse, assigned to care for a hospitalized child who is 8 years old, assists with planning care, taking into account Erik Erikson's theory of psychosocial development. According to Erikson's theory, which task represents the primary developmental task of this child?

• A. Developing a sense of control over self and body functions
• B. Mastering useful skills and tools
• C. Gaining independence from parents
• D. Developing a sense of trust in the world

Correct answer: B

Rationale: According to Erikson's theory of psychosocial development, the primary task for an 8-year-old child aligns with the stage of industry versus inferiority. This stage focuses on mastering useful skills and tools of the culture, emphasizing competence in various areas. Option A, 'Developing a sense of control over self and body functions,' is more characteristic of the toddler stage, emphasizing autonomy and self-regulation. Option C, 'Gaining independence from parents,' is more relevant to the adolescent stage, where identity development and autonomy become crucial. Option D, 'Developing a sense of trust in the world,' pertains to the infant stage, highlighting the importance of forming secure attachments. Therefore, the correct answer is B as it directly corresponds to the developmental tasks associated with an 8-year-old child according to Erikson's theory.

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