Nursing Elites

1. A nurse in a clinic receives a phone call from a client who would like information about pregnancy testing. Which of the following information should the nurse provide to the client?

• A. You should wait 4 weeks after conception to be tested for pregnancy.
• B. You should be off any medications for 24 hours prior to the pregnancy test.
• C. You should not eat or drink for at least 8 hours prior to the pregnancy test.
• D. You should use your first morning urination specimen for a home pregnancy test.

Correct answer: D

Rationale: For the most accurate results, a home pregnancy test should be done using the first morning urine, which contains the highest concentration of hCG.

2. A healthcare provider is assisting with the care for a client who reports manifestations of preterm labor. Which of the following findings are risk factors for this condition? (Select all that apply)

• A. Urinary tract infection
• B. Multifetal pregnancy
• C. Oligohydramnios
• D. All of the Above

Correct answer: D

Rationale: The correct answer is D: All of the Above. Multiple risk factors can contribute to preterm labor, including urinary tract infection, multifetal pregnancy, and oligohydramnios. These factors can lead to the uterus being irritated or overstimulated, potentially triggering early labor. Urinary tract infections can cause inflammation and contractions, multifetal pregnancies have a higher risk of preterm labor due to increased uterine stretching, and oligohydramnios can lead to poor fetal growth and premature contractions. Therefore, clients presenting with these conditions require close monitoring and management to prevent preterm birth. Choices A, B, and C are all correct risk factors for preterm labor, making option D the correct answer.

3. A client who is at 36 weeks of gestation and has a prescription for a nonstress test is being taught by a nurse. Which of the following statements should the nurse include in the teaching?

• A. You will receive IV fluid before this test.
• B. The procedure will take approximately 10 to 15 minutes.
• C. You will be offered orange juice to drink during the test.
• D. You will need to sign an informed consent form before each test.

Correct answer: C

Rationale: The correct statement the nurse should include in the teaching is that the client will be offered orange juice to drink during the nonstress test. This is because offering the client orange juice, or another beverage high in glucose, will help stimulate the fetus during the procedure, aiding in obtaining accurate results. Choice A is incorrect because IV fluid is not typically administered before a nonstress test. Choice B is incorrect as the procedure usually takes around 20 to 40 minutes. Choice D is incorrect as informed consent is typically obtained once for the procedure, not before each individual test.

4. A client who is postpartum has a slightly boggy and displaced fundus to the right. Which of the following actions should the nurse take based on these findings?

• A. Encourage the client to perform Kegel exercises.
• B. Encourage the client to move to the left lateral position.
• C. Ask the client to rate her pain.
• D. Assist the client to the bathroom to void.

Correct answer: D

Rationale: A displaced and boggy fundus in a postpartum client typically indicates a full bladder, which can impede uterine contractions and increase the risk of postpartum hemorrhage. Assisting the client to the bathroom to void helps ensure the bladder is empty, aiding the fundus to contract and reducing the risk of complications. Encouraging Kegel exercises, changing positions, or assessing pain would not directly address the issue of the boggy fundus caused by a full bladder.

5. A healthcare provider is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification?

• A. Assess deep tendon reflexes every hour.
• B. Obtain a daily weight.
• C. Continuous fetal monitoring
• D. Ambulate twice daily

Correct answer: D

Rationale: The correct answer is D. Ambulating twice daily is not recommended for a client with severe preeclampsia. Clients with severe preeclampsia are at risk for seizures and should be on bed rest to prevent complications. Ambulation can increase blood pressure and the risk of seizure activity in these clients. Assessing deep tendon reflexes, obtaining a daily weight, and continuous fetal monitoring are all appropriate and important interventions for a client with severe preeclampsia to monitor for signs of worsening condition and fetal well-being.

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