Nursing Elites

1. Why is a client with gestational diabetes being scheduled for an amniocentesis when the fetus has an estimated weight of eight pounds (3629 grams) at 36 weeks gestation? What information is the amniocentesis seeking to obtain?

• A. Presence of a neural tube defect.
• B. Chromosomal abnormalities.
• C. Gender of the fetus.
• D. Fetal lung maturity.

Correct answer: D

Rationale: An amniocentesis in this scenario is most likely being performed to assess fetal lung maturity. This is necessary when considering early delivery due to macrosomia (large fetal size), which is a common concern in gestational diabetes. Evaluating fetal lung maturity is crucial to determine if the fetus's lungs are developed enough to support breathing independently outside the womb. The presence of a neural tube defect and chromosomal abnormalities are not typically assessed through amniocentesis in this situation, and determining the gender of the fetus is not the primary purpose of the procedure here.

2. 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.

3. A newborn with a respiratory rate of 40 breaths per minute at one minute after birth is demonstrating cyanosis of the hands and feet. What action should a nurse take?

• A. Assess bowel sounds.
• B. Continue to monitor.
• C. Assist with intubation.
• D. Rub the infant's back.

Correct answer: B

Rationale: Cyanosis of the hands and feet, known as acrocyanosis, is common in newborns shortly after birth and usually resolves on its own. It is not indicative of a need for immediate intervention. Therefore, the appropriate action is to continue monitoring the newborn's condition. Assessing bowel sounds (Choice A) is not relevant to the presenting issue of cyanosis and respiratory rate. Assisting with intubation (Choice C) is an invasive procedure that is not warranted based on the information provided. Rubbing the infant's back (Choice D) is not necessary for acrocyanosis and could potentially disturb the newborn.

4. Individuals with Klinefelter syndrome produce:

• A. less estrogen than normal males.
• B. less testosterone than normal males.
• C. less adenine than normal males.
• D. less thymine than normal males.

Correct answer: B

Rationale: Individuals with Klinefelter syndrome have an extra X chromosome (XXY), leading to reduced production of testosterone, the primary male sex hormone. This deficiency can result in various physical and developmental characteristics associated with the syndrome. Estrogen levels may actually be relatively elevated due to the imbalance between testosterone and estrogen. Choices C and D are incorrect as adenine and thymine are nucleotide bases found in DNA and are not related to hormone production.

5. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Urine protein concentration of 200 mg/24 hr.
• B. Creatinine level of 0.8 mg/dL
• C. Hemoglobin level of 14.8 g/dL
• D. Platelet count of 60,000/mm3

Correct answer: D

Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.

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