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. The client is admitted in active labor with a cervix that is 3 cm dilated, 50% effaced, and the presenting part at 0 station. An hour later, the client expresses the need to go to the bathroom. Which action should the nurse implement first?

• A. Palpate the client’s bladder.
• B. Check the pH of the vaginal fluid.
• C. Review the fetal heart rate pattern.
• D. Determine cervical dilation.

Correct answer: D

Rationale: The nurse should prioritize determining cervical dilation as it helps in assessing the progress of labor and ensures it is safe for the client to move. Changes in cervical dilation may indicate the advancement of labor, warranting appropriate interventions or restrictions on movement to prevent complications. While checking the client's bladder may be important to ensure it's not distended, determining cervical dilation takes precedence in this scenario. Checking the pH of the vaginal fluid is not relevant in this situation, and reviewing the fetal heart rate pattern, although important, is not the first action to take when the client expresses the need to go to the bathroom.

3. The nurse is caring for a postpartum client who is exhibiting symptoms of a spinal headache 24 hours following the delivery of a normal newborn. Prior to the anesthesiologist's arrival on the unit, which action should the nurse perform?

• A. Apply an abdominal binder.
• B. Cleanse the spinal injection site.
• C. Insert an indwelling Foley catheter.
• D. Place procedure equipment at the bedside.

Correct answer: A

Rationale: In a postpartum client exhibiting symptoms of a spinal headache, applying an abdominal binder is a priority action. The abdominal binder can help reduce the severity of a spinal headache by increasing intra-abdominal pressure, which may relieve pressure on the dural sac and alleviate symptoms. This intervention can be performed promptly by the nurse to provide immediate relief while waiting for further evaluation and management by the anesthesiologist. Cleansing the spinal injection site (Choice B) is not the priority in this situation as the headache is likely due to a dural puncture during epidural anesthesia rather than infection. Inserting an indwelling Foley catheter (Choice C) and placing procedure equipment at the bedside (Choice D) are not the appropriate actions to address a spinal headache and should not take precedence over applying an abdominal binder.

4. A new mother who is breastfeeding her 4-week-old infant and has type 1 diabetes reports that her insulin needs have decreased since the birth of her child. Which action should the nurse implement?

• A. Inform her that a decreased need for insulin occurs while breastfeeding.
• B. Counsel her to increase her caloric intake.
• C. Advise the client to breastfeed more frequently.
• D. Schedule an appointment for the client with the diabetic nurse educator.

Correct answer: A

Rationale: The correct answer is A. During breastfeeding, insulin needs often decrease due to the metabolic demands of milk production. Therefore, the nurse should inform the client that this decrease in insulin requirements is a normal response to breastfeeding. Choice B is incorrect as increasing caloric intake is not directly related to the decrease in insulin needs during breastfeeding. Choice C is incorrect as advising the client to breastfeed more frequently does not address the issue of decreased insulin needs. Choice D is incorrect as scheduling an appointment with the diabetic nurse educator is not necessary at this point since the decreased need for insulin is a common physiological response to breastfeeding.

5. A pregnant woman in her first trimester is experiencing watery vaginal discharge. What should the nurse tell her?

• A. Inform her that it is normal.
• B. Advise her to see a doctor immediately.
• C. Suggest using panty liners.
• D. Suggest a change in diet.

Correct answer: A

Rationale: Informing the pregnant woman that watery vaginal discharge is normal during the first trimester is crucial to providing reassurance and reducing anxiety. This discharge, known as leukorrhea, is common during pregnancy due to increased estrogen levels and increased blood flow to the pelvic area. It helps maintain a healthy balance of bacteria in the vagina and protects the birth canal from infection. Advising the woman to see a doctor immediately may cause unnecessary alarm, while suggesting the use of panty liners can help manage the discharge comfortably. Suggesting a change in diet is not relevant to addressing watery vaginal discharge in this scenario.

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