Nursing Elites

1. A healthcare provider is reinforcing teaching with a client about a new prescription for medroxyprogesterone. Which of the following information should the provider include in the teaching? (Select all that apply)

• A. Weight fluctuations can occur.
• B. Irregular vaginal spotting can occur.
• C. You should increase your intake of calcium.
• D. All of the above

Correct answer: D

Rationale: When educating a client about medroxyprogesterone, it is important to include information about potential side effects and recommendations. Weight fluctuations and irregular vaginal spotting are common side effects of medroxyprogesterone. Additionally, increasing calcium intake is often advised to counteract the potential bone density loss associated with this medication. Therefore, all the statements provided are correct, making option D the correct answer. Choices A, B, and C are all essential pieces of information that the healthcare provider should convey to the client regarding medroxyprogesterone.

2. When reviewing postpartum nutrition needs with breastfeeding clients, which statement indicates an understanding of the teaching?

• A. I am glad I can have my morning coffee.
• B. I should take folic acid to increase my milk supply.
• C. I will continue adding 330 calories per day to my diet.
• D. I will continue my calcium supplements because I don't like milk.

Correct answer: D

Rationale: The correct answer is D. Clients who do not like milk should continue taking calcium supplements to ensure they meet their increased calcium needs while breastfeeding. Calcium is essential for bone health, and during breastfeeding, the mother's calcium requirements are higher. While caffeine in coffee can be consumed in moderation, folic acid does not directly impact milk supply, and the additional 330 calories per day are recommended but not the focus of this question.

3. A healthcare provider is preparing to administer vitamin K by IM injection to a newborn. The medication should be administered into which of the following muscles?

• A. Vastus lateralis
• B. Ventrogluteal
• C. Dorsogluteal
• D. Deltoid

Correct answer: A

Rationale: Vitamin K is typically administered in the vastus lateralis muscle of a newborn to prevent bleeding disorders. The vastus lateralis muscle is the preferred site for IM injections in infants due to its size and accessibility, allowing for easy and safe administration. The ventrogluteal and dorsogluteal sites are more commonly used in adults due to better muscle mass and less risk of injury to nearby structures. The deltoid muscle is typically used for older children and adults for IM injections, as it is a well-developed muscle suitable for injections in these populations.

4. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

• A. Late decelerations
• B. Moderate variability of the FHR
• C. Cessation of uterine dilation
• D. Prolonged active phase of labor

Correct answer: A

Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.

5. A client who is 2 days postpartum has a saturated perineal pad with bright red lochia containing small clots. What should the nurse document in the client's medical record?

• A. Moderate lochia rubra
• B. Excessive lochia serosa
• C. Light lochia rubra
• D. Scant lochia serosa

Correct answer: A

Rationale: The correct answer is 'Moderate lochia rubra.' On the second day postpartum, it is normal for lochia to be bright red and contain small clots, indicating moderate lochia rubra. This amount of bleeding is expected as the uterus continues to shed its lining after childbirth. Excessive lochia serosa, light lochia rubra, and scant lochia serosa do not accurately reflect the described scenario. Excessive lochia serosa is more characteristic of a later postpartum period, while light and scant lochia serosa are not consistent with the bright red color and small clots observed in this case.

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