Nursing Elites

1. 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.

2. While caring for a laboring client on continuous fetal monitoring, the nurse notes a fetal heart rate pattern that falls and rises abruptly with a 'V' shaped appearance. What action should the nurse take first?

• A. Change the maternal position.
• B. Administer oxygen at 10 L by mask.
• C. Prepare for a potential cesarean.
• D. Allow the client to begin pushing.

Correct answer: A

Rationale: In cases of fetal heart rate patterns showing abrupt falls and rises with a 'V' shaped appearance, it indicates possible cord compression. Changing the maternal position, such as moving the mother onto her side, can relieve the pressure off the cord and help improve fetal oxygenation, making it the priority intervention to address the decelerations.

3. A 38-week primigravida who works at a desk job and sits at a computer for 8 hours each day tells the nurse that her feet have begun to swell. Which instruction would be most effective in preventing pooling of blood in the lower extremities?

• A. Wear support stockings.
• B. Reduce salt in her diet.
• C. Move about every hour.
• D. Avoid constrictive clothing.

Correct answer: C

Rationale: During pregnancy, especially in the third trimester, it is common for women to experience swelling due to decreased circulation. Encouraging the patient to move about every hour helps prevent blood pooling in the lower extremities by promoting circulation. This simple activity can help alleviate swelling and discomfort associated with prolonged sitting.

4. What is the best nursing intervention for a pregnant woman with hyperemesis gravidarum?

• A. Administer prescribed IV solution.
• B. Give oral rehydration solution.
• C. Encourage small, frequent meals.
• D. Offer ginger tea to reduce nausea.

Correct answer: A

Rationale: The best nursing intervention for a pregnant woman with hyperemesis gravidarum is to administer the prescribed IV solution. Hyperemesis gravidarum is a severe form of nausea and vomiting during pregnancy that can lead to dehydration and electrolyte imbalances. Administering IV fluids helps in managing dehydration, replenishing electrolytes, and providing the necessary hydration for both the mother and the fetus. Giving oral rehydration solution (Choice B) may not be sufficient for severe cases of hyperemesis gravidarum where IV fluids are required. Encouraging small, frequent meals (Choice C) may not be effective as the woman may not be able to tolerate oral intake. Offering ginger tea (Choice D) is not the most appropriate intervention for hyperemesis gravidarum, as it may not provide adequate hydration or electrolyte balance needed in severe cases.

5. A new mother is having trouble breastfeeding her newborn son. He is making frantic rooting motions and will not grasp the nipple. What intervention would be most helpful to this mother?

• A. Ask the mother to stop feeding, comfort the infant, and then assist the mother to help the baby latch on.
• B. Use a nipple shield to help the baby latch on.
• C. Try a different breastfeeding position.
• D. Have another person help the mother with breastfeeding.

Correct answer: A

Rationale: In this scenario, the best intervention is to ask the mother to stop feeding, comfort the infant, and then assist her in helping the baby latch on. Stopping the feeding and providing comfort can reduce the infant's frustration and create a calmer environment for successful breastfeeding. Choice B, using a nipple shield, may not address the underlying issue causing the baby's difficulty latching. Choice C, trying a different breastfeeding position, can be attempted after the baby is calm and ready to latch. Choice D, having another person help, may not be necessary if the mother can be guided effectively on latching techniques.

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