Nursing Elites

1. Four clients at full term present to the labor and delivery unit at the same time. Which client should a nurse assess first?

• A. Multipara with contractions occurring every three minutes
• B. Multipara scheduled for non-stress test and biophysical profile
• C. Primipara with vaginal show and leaking membranes
• D. Primipara with burning on urination and urinary frequency

Correct answer: C

Rationale: A primipara with vaginal show and leaking membranes requires immediate assessment as she may be in active labor or at risk of infection. The vaginal show and leaking membranes suggest potential rupture of membranes and the start of labor. Assessing her first ensures prompt management and monitoring. The other options, while important, do not indicate immediate or emergent needs. Contractions every three minutes in a multipara can be managed with ongoing monitoring; non-stress tests and biophysical profiles can be scheduled and are not acute needs. Burning on urination and urinary frequency in a primipara may indicate a urinary tract infection, which is important but not as urgent as assessing for active labor or rupture of membranes.

2. A client is preparing to administer methylergonovine 0.2 mg orally to a client who is 2 hr postpartum and has a boggy uterus. For which of the following assessment findings should the nurse withhold the medication?

• A. Blood pressure 142/92 mm Hg
• B. Urine output 100 mL in 1 hr
• C. Pulse 58/min
• D. Respiratory rate 14/min

Correct answer: A

Rationale: The correct answer is A. Methylergonovine can increase blood pressure, so it should be withheld if the client has hypertension. A blood pressure reading of 142/92 mm Hg indicates hypertension and is a contraindication for administering methylergonovine. Choices B, C, and D are within normal limits and not contraindications for administering this medication. Urine output, pulse rate, and respiratory rate are not factors that determine the appropriateness of administering methylergonovine in this situation.

3. In the structure of deoxyribonucleic acid (DNA), which of the following bases combines with thymine?

• A. Cytosine
• B. Adenine
• C. Rhodamine
• D. Serine

Correct answer: B

Rationale: The correct answer is B: Adenine. In the structure of DNA, adenine pairs with thymine through hydrogen bonding, forming one of the complementary base pairs that make up the double helix structure of DNA. Cytosine pairs with guanine, not thymine. Rhodamine and serine are not DNA bases and do not participate in DNA base pairing. Therefore, choices A, C, and D are incorrect.

4. When should the low-risk patient, who is 16 weeks pregnant, be advised to return to the prenatal clinic?

• A. 1 week.
• B. 2 weeks.
• C. 3 weeks.
• D. 4 weeks.

Correct answer: D

Rationale: The correct answer is D: 4 weeks. Low-risk pregnant patients typically have prenatal visits every 4 weeks until 28 weeks of gestation. This frequency allows for adequate monitoring of the pregnancy without being overly burdensome on the patient. Choices A, B, and C are incorrect as they do not align with the standard prenatal care schedule for low-risk pregnancies. Visits that are too frequent may cause unnecessary anxiety for the patient, while visits that are too infrequent may miss important opportunities for monitoring and intervention.

5. When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?

• A. Dilation of the cervix.
• B. Descent of the fetus to –2 station.
• C. Rupture of the amniotic membranes.
• D. Increase in bloody show.

Correct answer: A

Rationale: During the first stage of labor, effective uterine contractions lead to cervical dilation. Dilation of the cervix is a key indicator that uterine contractions are progressing labor. Descent of the fetus to -2 station (Choice B) is related to the fetal position in the pelvis and not a direct indicator of uterine contraction effectiveness. Rupture of the amniotic membranes (Choice C) signifies the rupture of the fluid-filled sac surrounding the fetus and does not directly reflect uterine contraction effectiveness. An increase in bloody show (Choice D) can be a sign of impending labor, but it is not a direct indicator of uterine contraction effectiveness.

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