Nursing Elites

1. During a well-child visit for their child, one of the parents with an autosomal dominant disorder tells the nurse, 'We don’t plan on having any more children, since the next child is likely to inherit this disorder.' How should the nurse respond?

• A. Explain that the risk of inheriting the disorder decreases by 50% with each child the couple has.
• B. Acknowledge that the next child will inherit the disorder since the first child did not.
• C. Encourage the couple to reconsider their decision since the inheritance pattern may be sex-linked.
• D. Confirm that there is a 50% chance of their future children inheriting the disorder.

Correct answer: D

Rationale: Confirming that there is a 50% chance of their future children inheriting the disorder is the correct response in this situation. Autosomal dominant disorders have a 50% chance of being passed on to each child. Providing accurate genetic counseling is essential to help the parents make informed decisions about family planning. Choices A, B, and C are incorrect. Choice A is inaccurate because the risk of inheriting an autosomal dominant disorder remains at 50% for each child regardless of the number of children the couple has. Choice B is not appropriate as it does not provide helpful information or support to the parents. Choice C is misleading because autosomal dominant disorders follow a specific inheritance pattern and are not sex-linked.

2. A client at 28 weeks gestation calls the antepartum clinic and reports experiencing a small amount of bright red vaginal bleeding without uterine contractions or abdominal pain. What instruction should the LPN/LVN provide?

• A. Come to the clinic today for an ultrasound.
• B. Go immediately to the emergency room.
• C. Lie on your left side for about one hour and see if the bleeding stops.
• D. Bring a urine specimen to the lab tomorrow to determine if you have a urinary tract infection.

Correct answer: A

Rationale: Bright red vaginal bleeding without pain could indicate placental issues such as previa. An ultrasound is necessary to evaluate the cause. It is important to rule out potential serious conditions like placental previa, which can lead to further complications for both the mother and the fetus. Therefore, prompt evaluation through an ultrasound at the clinic is essential for appropriate management and ensuring the well-being of the client and her baby.

3. The LPN/LVN caring for a laboring client encourages her to void at least q2h, and records each time the client empties her bladder. What is the primary reason for implementing this nursing intervention?

• A. Emptying the bladder during delivery is difficult because of the position of the presenting fetal part.
• B. An over-distended bladder could be traumatized during labor as well as prolong the progress of labor.
• C. Urine specimens for glucose and protein must be obtained at certain intervals throughout labor.
• D. Frequent voiding minimizes the need for catheterization, which increases the chance of bladder infection.

Correct answer: B

Rationale: The primary reason for encouraging the laboring client to void regularly is to prevent an over-distended bladder, which could impede the descent of the fetus, prolong labor, and be at risk for trauma during delivery. Choice A is incorrect because the difficulty in emptying the bladder during delivery is not the main reason for this nursing intervention. Choice C is incorrect as it pertains to obtaining urine specimens for glucose and protein, not the primary reason for encouraging voiding. Choice D is incorrect because although frequent voiding can indeed minimize the need for catheterization, the primary reason is to prevent an over-distended bladder and potential complications.

4. A couple has been trying to conceive for nine months without success. Which information obtained from the clients is most likely to have an impact on the couple's ability to conceive a child?

• A. Both partners have a daily exercise regimen that includes running four miles each morning.
• B. The couple has a history of having sexual intercourse 2 to 3 times per week.
• C. The woman's menstrual period occurs every 35 days.
• D. They use lubricants with each sexual encounter to decrease friction.

Correct answer: D

Rationale: Using lubricants during sexual encounters can potentially impact the couple's ability to conceive a child. Some lubricants may contain substances that are spermicidal or alter the vaginal environment, affecting sperm motility and fertility.

5. What action should the nurse take if an infant, who was born yesterday weighing 7.5 lbs (3,402 grams), weighs 7 lbs (3,175 grams) today?

• A. Inform and assure the mother that this is normal weight loss.
• B. Encourage the mother to increase the frequency of breastfeeding.
• C. After verifying the accuracy of weight, notify the healthcare provider.
• D. Monitor the stool and urine output of the neonate for the last 24 hours.

Correct answer: A

Rationale: The correct action for the nurse to take in this situation is to inform and assure the mother that this weight loss is normal. Newborns can lose up to 10% of their birth weight in the first few days after birth, which is attributed to fluid loss and adjustment to life outside the womb. This weight loss is typically regained within the first two weeks of life. It is crucial for the nurse to educate and provide reassurance to the mother about this common occurrence in newborns.

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