Nursing Elites

1. The _____ is the inner layer of the embryo from which the lungs and digestive system develop.

• A. neural tube
• B. mesoderm
• C. endoderm
• D. umbilical cord

Correct answer: C

Rationale: The endoderm is the correct answer. It is the innermost layer of the embryo that gives rise to organs such as the lungs, digestive system, liver, and pancreas. The neural tube (Choice A) forms the brain and spinal cord, not the lungs or digestive system. Mesoderm (Choice B) develops into structures like muscles, bones, and circulatory system, not the lungs or digestive system. The umbilical cord (Choice D) serves as a connection between the embryo and the placenta, providing nutrients and oxygen, but it is not the layer from which lungs and digestive system develop.

2. A woman who is 38 weeks gestation is receiving magnesium sulfate for severe preeclampsia. Which assessment finding warrants immediate intervention by the nurse?

• A. Dizziness while standing
• B. Sinus tachycardia
• C. Lower back pain
• D. Absent patellar reflexes

Correct answer: D

Rationale: The correct answer is D: Absent patellar reflexes. Absent patellar reflexes can indicate magnesium toxicity, a serious condition that requires immediate intervention to prevent respiratory depression or cardiac arrest. Dizziness while standing (choice A) is common in pregnancy but does not specifically indicate magnesium toxicity. Sinus tachycardia (choice B) can be a normal response to magnesium sulfate but does not indicate toxicity. Lower back pain (choice C) is common in pregnancy and not specifically associated with magnesium toxicity.

3. A nurse on the labor and delivery unit is assessing four clients. Which of the following clients is a candidate for an induction of labor with misoprostol?

• A. A client who has active genital herpes
• B. A client who has gestational diabetes mellitus
• C. A client who has a previous uterine incision
• D. A client who has placenta previa

Correct answer: B

Rationale: Misoprostol can be used for induction in clients with gestational diabetes mellitus. Choice A, a client with active genital herpes, is not a candidate for misoprostol induction due to the risk of viral shedding and transmission. Choice C, a client with a previous uterine incision, may be at risk for uterine rupture with misoprostol use. Choice D, a client with placenta previa, is not an appropriate candidate for misoprostol induction due to the risk of increased bleeding associated with the condition.

4. When children who are reared by adoptive parents are nonetheless more similar to their natural parents in a trait, it can be concluded that:

• A. the genetic characteristics of the children change over time.
• B. heredity is solely responsible for how a child grows.
• C. the environment is solely responsible for the development of those characteristics.
• D. genetics play a role in the development of those characteristics.

Correct answer: D

Rationale: When children exhibit traits that are more similar to their biological parents than their adoptive parents, it indicates a strong genetic influence on those traits. This similarity suggests that genetics play a significant role in the development of the observed characteristics. Choice A is incorrect because genetic characteristics do not change over time in this context. Choice B is incorrect as it implies that heredity is the only factor, disregarding the impact of the environment. Choice C is also incorrect as it suggests that only the environment influences trait development, overlooking the genetic contribution.

5. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?

• A. Perform a guaiac test and record the results.
• B. Recognize the finding as abnormal and report it to the primary health care provider.
• C. Recognize the finding as a normal result of iron therapy.
• D. Check the woman’s next stool to validate the observation.

Correct answer: C

Rationale: The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. Dark stools are a known, expected result of iron supplementation and are not indicative of a complication unless other symptoms of GI bleeding are present. A guaiac test would be necessary if there were concerns about gastrointestinal bleeding. Recognizing dark stools as a consequence of iron therapy is an essential nursing assessment skill and does not require immediate reporting. Checking the next stool to confirm the observation is unnecessary as the presence of dark stools in this context is already an expected outcome of iron supplementation.

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