Nursing Elites

1. 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.

2. A newborn is being assessed by a nurse who was born post-term. Which of the following findings should the nurse expect?

• A. Nails extending over tips of fingers
• B. Large deposits of subcutaneous fat
• C. Pale, translucent skin
• D. Thin covering of fine hair on shoulders and back

Correct answer: A

Rationale: Post-term newborns often have longer nails that extend over the tips of their fingers due to the extended gestation period. This occurs because the baby continues to grow in utero past the typical 40 weeks of gestation. Choices B, C, and D are incorrect as large deposits of subcutaneous fat, pale translucent skin, and a thin covering of fine hair on shoulders and back are not typically associated with post-term newborns. Longer nails are a common finding in post-term newborns due to the prolonged time spent in the womb, allowing for more nail growth compared to infants born at term.

3. Is color blindness a sex-linked abnormality?

• A. TRUE
• B. FALSE
• C. Sometimes
• D. Always

Correct answer: A

Rationale: The correct answer is A: TRUE. Color blindness is indeed a sex-linked abnormality as it is often associated with genes on the X chromosome. Since males have only one X chromosome, they are more likely to inherit color blindness if the gene is present. This makes color blindness more common in males. Choice B (FALSE) is incorrect because color blindness is linked to the X chromosome. Choices C (Sometimes) and D (Always) are incorrect as color blindness is consistently tied to the X chromosome.

4. A client at 34 weeks gestation comes to the birthing center complaining of vaginal bleeding that began one hour ago. The nurse's assessment reveals approximately 30ML of bright red vaginal bleeding, fetal heart rate of 130 - 140 beats per minute, no contractions, and no complaints of pain. What is the most likely cause of this client's bleeding?

• A. Abruptio Placenta
• B. Placenta Previa
• C. Normal bloody show indicating induction of labor
• D. A ruptured blood vessel in the vaginal vault

Correct answer: B

Rationale: Placenta previa, a condition where the placenta covers the cervix, can cause painless, bright red vaginal bleeding in the third trimester. In this scenario, the absence of contractions and pain, along with the presence of significant bright red bleeding, is more indicative of placenta previa rather than abruptio placenta or a ruptured vessel. A normal bloody show typically occurs closer to the onset of labor and is not associated with the amount of bleeding described in the question.

5. What causes Down's syndrome?

• A. Alcohol abuse by the mother at the time of conception.
• B. Sex-linked chromosomal abnormalities.
• C. An extra chromosome on the 21st pair.
• D. Drug abuse by the mother during pregnancy.

Correct answer: C

Rationale: Down's syndrome, also known as trisomy 21, is caused by the presence of an extra chromosome on the 21st pair. Choice A is incorrect as alcohol abuse is not the cause of Down's syndrome. Choice B is incorrect because Down's syndrome is not related to sex-linked chromosomal abnormalities. Choice D is also incorrect as drug abuse by the mother during pregnancy is not the cause of Down's syndrome.

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