Nursing Elites

1. When does the fetus typically begin to turn and respond to external stimulation during pregnancy?

• A. During the second or third week
• B. After the first trimester
• C. Sometimes
• D. Never

Correct answer: B

Rationale: The correct answer is B. The fetus typically begins to respond to external stimulation much later in pregnancy, usually after the first trimester. During the second or third week of pregnancy, the fetus is still in the early stages of development and is not yet capable of turning or responding to external stimuli. Choices A, C, and D are incorrect because they do not accurately reflect the timeline of fetal development when it comes to responding to external stimulation.

2. The healthcare provider is planning care for a client at 30 weeks gestation who is experiencing preterm labor. Which medication is most important in preventing this fetus from developing respiratory distress syndrome?

• A. Ampicillin 1 gram IV push every 8 hours
• B. Betamethasone 12 mg deep IM
• C. Terbutaline 0.25 mg subcutaneously every 15 minutes for 3 doses
• D. Butorphanol tartrate 1 mg IV push every 2 hours as needed

Correct answer: B

Rationale: Betamethasone is a corticosteroid given to stimulate fetal lung maturity and reduce the risk of respiratory distress syndrome in preterm infants. Ampicillin (Choice A) is an antibiotic and does not prevent respiratory distress syndrome. Terbutaline (Choice C) is a tocolytic used to inhibit contractions and does not directly prevent respiratory distress syndrome. Butorphanol tartrate (Choice D) is an opioid analgesic and does not have a role in preventing respiratory distress syndrome in preterm infants.

3. A primigravida at 36 weeks gestation who is RH-negative experienced abdominal trauma in a motor vehicle collision. Which assessment finding is most important for the nurse to report to the healthcare provider?

• A. Fetal heart rate at 162 beats per minute
• B. Mild contractions every 10 minutes
• C. Trace of protein in the urine
• D. Positive fetal hemoglobin testing

Correct answer: D

Rationale: The correct answer is 'Positive fetal hemoglobin testing' (D). Positive fetal hemoglobin testing (Kleihauer-Betke test) indicates fetal-maternal hemorrhage, which is critical in an RH-negative mother due to the risk of isoimmunization. This condition can lead to sensitization of the mother's immune system against fetal blood cells, potentially causing hemolytic disease of the newborn in subsequent pregnancies. Reporting this finding promptly is crucial for appropriate management and interventions. Choices A, B, and C are not as critical in this scenario. While monitoring fetal heart rate and contractions is important, the detection of fetal-maternal hemorrhage takes precedence due to the serious implications it poses for the current and future pregnancies of an RH-negative mother.

4. A client at 26 weeks gestation was informed this morning that she has an elevated alpha-fetoprotein (AFP) level. After the healthcare provider leaves the room, the client asks what she should do next. What information should the nurse provide?

• A. Reassure the client that the AFP results are likely to be a false reading.
• B. Explain that a sonogram should be scheduled for definitive results.
• C. Inform her that a repeat alpha-fetoprotein (AFP) test should be evaluated.
• D. Discuss options for intrauterine surgical correction of congenital defects.

Correct answer: B

Rationale: An elevated AFP level during pregnancy can indicate potential fetal anomalies. Further evaluation is necessary to confirm the findings and assess the need for additional interventions. Scheduling a sonogram is the appropriate next step as it can provide more definitive results and help identify any underlying issues. Choice A is incorrect because dismissing the elevated AFP level as a false reading without further investigation can lead to missing important information about the baby's health. Choice C is not the best immediate action, as scheduling a sonogram would provide more detailed information than just repeating the AFP test. Choice D is incorrect as discussing intrauterine surgical correction is premature at this stage and not typically indicated based solely on an elevated AFP level.

5. The nurse is caring for a multiparous client who is 8 centimeters dilated, 100% effaced, and the fetal head is at 0 station. The client is shivering and states extreme discomfort with the urge to bear down. Which intervention should the nurse implement?

• A. Administer IV pain medication
• B. Perform a vaginal exam
• C. Reposition to side-lying
• D. Encourage pushing with each contraction

Correct answer: C

Rationale: Repositioning the client to a side-lying position is the most appropriate intervention in this scenario. This position can help relieve pressure on the cervix and reduce the urge to push prematurely, allowing the cervix to continue dilating. Administering IV pain medication may not address the underlying cause of the discomfort, and pushing prematurely can lead to cervical trauma. Performing a vaginal exam is not necessary at this point as the client is already 8 centimeters dilated, and the fetal head is at 0 station.

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