Nursing Elites

1. A client at 39 weeks of gestation in a prenatal clinic asks about signs preceding labor. Which of the following should the nurse identify as a sign that precedes labor?

• A. Decreased vaginal discharge
• B. A surge of energy
• C. Urinary retention
• D. Weight gain of 0.5 to 1.5 kg

Correct answer: B

Rationale: A surge of energy is a common sign that precedes labor. This burst of energy, often referred to as the 'nesting instinct,' is believed to occur as the body prepares for labor, prompting the individual to undertake tasks to prepare for the arrival of the baby. Decreased vaginal discharge is not a typical sign preceding labor. Urinary retention is not a sign that precedes labor and may indicate another issue. Weight gain of 0.5 to 1.5 kg is not a specific sign of impending labor.

2. A client is learning how to check basal temperature to determine ovulation. When should the client check her temperature?

• A. On days 13 to 17 of her menstrual cycle
• B. Every morning before arising
• C. 1 hour following intercourse
• D. Before going to bed every night

Correct answer: B

Rationale: The basal body temperature should be taken every morning before arising as it provides the most accurate reading. This time ensures consistency and eliminates variations that may occur throughout the day due to activities or environmental factors. Choice A is incorrect because ovulation can vary among individuals, and checking temperature on specific days may not align with the actual ovulation day. Choice C is incorrect as there is no direct correlation between intercourse and basal body temperature. Choice D is incorrect because taking the temperature before going to bed does not provide a consistent baseline reading.

3. A client who is 12 hours postpartum has a fundus located two fingerbreadths above the umbilicus, deviated to the right of the midline, and less firm than previously noted. Which of the following actions should the nurse take?

• A. Place the client in a side-lying position.
• B. Assist the client to the bathroom to void.
• C. Obtain a prescription for IV oxytocin.
• D. Administer methylergonovine.

Correct answer: B

Rationale: In this scenario, the client's fundus findings indicate a distended bladder, which can lead to uterine atony. Assisting the client to the bathroom to void is essential as a distended bladder can inhibit the uterus from contracting normally. This action can help the uterus contract effectively and prevent complications such as postpartum hemorrhage. Placing the client in a side-lying position, obtaining a prescription for IV oxytocin, or administering methylergonovine are not the priority actions in this situation. Placing the client in a side-lying position might be indicated for fundal displacement, but it is not the priority here. Obtaining a prescription for IV oxytocin and administering methylergonovine are interventions for managing uterine atony, which is not the primary issue in this case; the priority is addressing the distended bladder.

4. A client is being discharged after childbirth. At 4 weeks postpartum, the client should contact the provider for which of the following client findings?

• A. Scant, non-odorous white vaginal discharge
• B. Uterine cramping during breastfeeding
• C. Sore nipple with cracks and fissures
• D. Decreased response with sexual activity

Correct answer: C

Rationale: Sore nipples with cracks and fissures should be reported to the provider as this can indicate improper breastfeeding techniques or infection, which requires medical evaluation and intervention to prevent further complications such as mastitis or decreased milk supply. Scant, non-odorous white vaginal discharge is a normal finding postpartum. Uterine cramping during breastfeeding is also common due to oxytocin release. Decreased response with sexual activity may be expected at 4 weeks postpartum due to hormonal changes and fatigue, but it is not typically a concern that needs immediate medical attention.

5. A client who is pregnant states that her last menstrual period was April 1st. What is the client's estimated date of delivery?

• A. January 8
• B. January 15
• C. February 8
• D. February 15

Correct answer: A

Rationale: To calculate the estimated date of delivery, add 7 days to the first day of the last menstrual period (April 1st), which gives April 8th. Then, count forward 9 months from April 8th, leading to January 8th as the estimated date of delivery. Choice A is correct. Choice B is incorrect because it is exactly 9 months from the last menstrual period without accounting for the additional 7 days. Choices C and D are incorrect as they fall in February, which is beyond the 9-month period from the last menstrual period.

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