Nursing Elites

1. The nurse is caring for a 2-day old neonate who has not passed meconium and has a swollen abdomen. The healthcare provider reviews the flat plate X-ray of the abdomen and makes a tentative diagnosis of Hirschsprung's disease. Which pathophysiological process is consistent with this neonate's clinical picture?

• A. The congenital absence of parasympathetic ganglion cells to large intestine produces no peristalsis.
• B. Pyloric obstruction causes reflux and projectile hematemesis.
• C. Partial imperforated anal opening limits passage of stools.
• D. Peristalsis moving against the intestinal obstruction causing hyperactivity of the bowel.

Correct answer: A

Rationale: Hirschsprung's disease is caused by the absence of parasympathetic ganglion cells in the large intestine, leading to a lack of peristalsis and obstruction.

2. Upon admission to the prenatal clinic, a 23-year-old woman informs the nurse that her last menstrual period began on February 15, and that previously her periods were regular. Her pregnancy test is positive. What is this client's expected date of delivery (EDD)?

• A. November 22.
• B. November 8.
• C. December 22.
• D. October 22.

Correct answer: A

Rationale: To determine the expected date of delivery (EDD) using Nägele's rule, add 7 days to the first day of the last menstrual period (LMP) which is February 15, resulting in February 22. Then, subtract 3 months from February 22, which gives November 22 as the estimated due date.

3. A 26-year-old, gravida 2, para 1 client is admitted to the hospital at 28 weeks gestation in preterm labor. She is given 3 doses of terbutaline sulfate (Brethine) 0.25 mg subcutaneously to stop her labor contractions. The LPN/LVN plans to monitor for which primary side effect of terbutaline sulfate?

• A. Drowsiness and bradycardia.
• B. Depressed reflexes and increased respirations.
• C. Tachycardia and a feeling of nervousness.
• D. A flushed, warm feeling and a dry mouth.

Correct answer: C

Rationale: The primary side effects of terbutaline sulfate are related to its beta-adrenergic effects. Tachycardia and nervousness are common side effects of terbutaline sulfate. Tachycardia is expected due to the drug's beta-agonist properties, while nervousness can result from the stimulation of beta-adrenergic receptors. It is crucial to monitor the client for these side effects to ensure early recognition and appropriate management.

4. During a non-stress test (NST) at 41-weeks gestation, the LPN/LVN notes that the client is not experiencing contractions, the fetal heart rate (FHR) baseline is 144 bpm, and no FHR accelerations are present. What action should the nurse take?

• A. Check the client for urinary bladder distention.
• B. Notify the healthcare provider of the nonreactive results.
• C. Have the mother stimulate the fetus to move.
• D. Ask the client if she has felt any fetal movement.

Correct answer: D

Rationale: In this scenario, the nurse should ask the client if she has felt any fetal movement. This action is important as assessing for fetal movement can help determine if the absence of FHR accelerations is attributed to fetal sleep or decreased fetal activity. It is crucial to gather information directly from the client to aid in the assessment and decision-making process. This approach can provide valuable insights into the fetal well-being and guide further interventions if needed.

5. During a prenatal visit, the nurse discusses with a client the effects of smoking on the fetus. When compared with nonsmokers, mothers who smoke during pregnancy tend to produce infants who have

• A. lower Apgar scores.
• B. lower birth weights.
• C. respiratory distress.
• D. a higher rate of congenital anomalies.

Correct answer: B

Rationale: Smoking during pregnancy is associated with intrauterine growth restriction, leading to lower birth weights. This occurs due to the harmful effects of smoking on fetal development, which can result in reduced nutrient and oxygen supply to the fetus, impacting its overall growth and leading to lower birth weights. Choices A, C, and D are incorrect as smoking during pregnancy primarily affects fetal growth and development, leading to lower birth weights rather than lower Apgar scores, respiratory distress, or a higher rate of congenital anomalies.

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