Nursing Elites

1. At 12 hours after the birth of a healthy infant, the mother complains of feeling constant vaginal pressure. The nurse determines the fundus is firm and at midline with moderate rubra lochia. Which action should the nurse take?

• A. Check the suprapubic area for distention
• B. Inform the client to take a warm sitz bath
• C. Inspect the client's perineal and rectal areas
• D. Apply a fresh pad and check in 1 hour

Correct answer: C

Rationale: In this situation, the mother's complaint of constant vaginal pressure along with a firm fundus and moderate rubra lochia indicates a potential perineal injury or hematoma. The correct action for the nurse to take is to inspect the client's perineal and rectal areas to assess for any signs of trauma or hematoma. Checking the suprapubic area for distention (Choice A) is not the priority here since the symptoms suggest a perineal issue. Advising a warm sitz bath (Choice B) may not address the underlying issue and could potentially worsen any existing trauma. Applying a fresh pad and checking in 1 hour (Choice D) does not address the need for immediate assessment of the perineal and rectal areas in response to the reported symptoms.

2. A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light and asks for her nurse right away, stating 'I’m bleeding a lot.' What is the most likely cause of postpartum hemorrhage in this client?

• A. Retained placental fragments.
• B. Unrepaired vaginal lacerations.
• C. Uterine atony.
• D. Puerperal infection.

Correct answer: C

Rationale: Uterine atony is the most likely cause of bleeding 4 hours after delivery, especially after delivering a macrosomic infant and augmenting labor with oxytocin. Uterine atony is characterized by the inability of the uterine muscles to contract effectively after childbirth, leading to excessive bleeding. The other options, such as retained placental fragments (A), unrepaired vaginal lacerations (B), and puerperal infection (D), are less likely causes of postpartum hemorrhage in this scenario. Retained placental fragments can cause bleeding, but this typically presents earlier than 4 hours postpartum. Unrepaired vaginal lacerations would likely be evident sooner and not typically result in significant bleeding. Puerperal infection is not a common cause of immediate postpartum hemorrhage unless there are other signs of infection present.

3. Which field of biology studies heredity?

• A. Etiology.
• B. Ecology.
• C. Genetics.
• D. Eugenics.

Correct answer: C

Rationale: Genetics is the branch of biology that focuses on the study of heredity and variation in organisms. Etiology (choice A) deals with the causes of diseases, not heredity. Ecology (choice B) is concerned with the relationships between organisms and their environment, not specifically heredity. Eugenics (choice D) is a controversial field that involves improving the genetic quality of the human population through selective breeding, which is different from the study of heredity itself.

4. A client who is 28 weeks pregnant and not up-to-date on current immunizations should anticipate receiving which of the following immunizations following birth?

• A. Pneumococcal
• B. Hepatitis
• C. Human papillomavirus
• D. Rubella

Correct answer: D

Rationale: The correct answer is D, Rubella. Rubella vaccine is recommended postpartum to prevent congenital rubella syndrome in future pregnancies. Pneumococcal and Hepatitis vaccines are not routinely given postpartum. Human papillomavirus vaccine is not typically administered immediately after birth but rather at a later age to prevent HPV infections.

5. Which of the following statements is true of a sperm cell?

• A. A sperm cell is significantly larger than an egg cell.
• B. A sperm cell contains two Y chromosomes.
• C. A sperm cell travels randomly inside a woman’s reproductive tract.
• D. A sperm cell is one of the smallest types of cells in the body.

Correct answer: D

Rationale: The correct answer is D. A sperm cell is indeed one of the smallest cells in the human body, much smaller than an egg cell. Choice A is incorrect as sperm cells are much smaller than egg cells. Choice B is incorrect because a sperm cell carries either an X or a Y chromosome, not two Y chromosomes. Choice C is incorrect since sperm cells move in a purposeful manner guided by various factors within a woman's reproductive tract, not randomly.

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