Nursing Elites

1. A client in a prenatal clinic is pregnant and experiencing episodes of maternal hypotension. The client asks the nurse what causes these episodes. Which of the following responses should the nurse make?

• A. This is due to an increase in blood volume.
• B. This is due to pressure from the uterus on the diaphragm.
• C. This is due to the weight of the uterus on the vena cava.
• D. This is due to increased cardiac output.

Correct answer: C

Rationale: Maternal hypotension during pregnancy is often caused by the weight of the uterus pressing on the vena cava when the client is lying on her back, which reduces blood flow to the heart. This compression can lead to a decrease in blood pressure and subsequent symptoms of hypotension. Choice A is incorrect because an increase in blood volume typically leads to increased blood pressure rather than hypotension. Choice B is incorrect as pressure from the uterus on the diaphragm is not a common cause of maternal hypotension. Choice D is incorrect because increased cardiac output would not directly cause maternal hypotension.

2. A healthcare provider is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the provider expect? (Select all that apply)

• A. Chadwick's sign
• B. Goodell's sign
• C. Ballottement
• D. All of the above

Correct answer: D

Rationale: Chadwick's sign, Goodell's sign, and ballottement are probable signs of pregnancy. Chadwick's sign refers to a bluish discoloration of the cervix and vaginal mucosa. Goodell's sign is the softening of the cervix due to increased vascularity. Ballottement is the rebound of the fetus when the cervix is tapped during a vaginal examination. Recognizing these signs is essential for healthcare providers in assessing pregnancy. Therefore, all of the above choices are correct as they are all probable signs of pregnancy. Choice D is the correct answer as it includes all the expected findings.

3. A healthcare professional in the emergency department is caring for a client who presents with severe abdominal pain in the left lower quadrant. The provider suspects a ruptured ectopic pregnancy. Which of the following signs indicates to the healthcare professional that the client has blood in the peritoneum?

• A. Chvostek's sign
• B. Cullen's sign
• C. Chadwick's sign
• D. Goodell's sign

Correct answer: B

Rationale: Cullen's sign, which presents as bruising around the umbilicus, indicates the presence of blood in the peritoneum. This sign is significant in cases of a ruptured ectopic pregnancy as it suggests intraperitoneal bleeding, prompting immediate medical attention. Chvostek's sign is related to facial muscle spasm and is not indicative of peritoneal bleeding. Chadwick's sign refers to a bluish discoloration of the cervix and vagina during pregnancy, not related to peritoneal bleeding. Goodell's sign is a softening of the cervix, which is a sign of pregnancy, and not specific to peritoneal bleeding.

4. During a teaching session with a client in labor, a nurse is explaining episiotomy. Which of the following information should the nurse include?

• A. An episiotomy is a perineal incision made by the provider to facilitate delivery of the fetus
• B. A fourth-degree episiotomy extends into the rectal area and is not recommended
• C. An episiotomy is an incision made by the provider to facilitate delivery of the fetus
• D. A mediolateral episiotomy is preferred over a median episiotomy for most deliveries

Correct answer: C

Rationale: The correct answer is C because an episiotomy is an intentional incision made by the healthcare provider to widen the vaginal opening during delivery. This procedure is performed to facilitate the birth of the baby and prevent uncontrolled tearing of the perineum. It is important for the nurse to educate the client on the purpose and implications of episiotomy to ensure informed decision-making and proper postpartum care. Choice A is incorrect because an episiotomy is not a perineal tear but a deliberate incision. Choice B is incorrect because a fourth-degree episiotomy extending into the rectal area is not a standard practice and can lead to complications. Choice D is incorrect because a mediolateral episiotomy is not universally considered easier to repair than a median episiotomy; the choice of incision type depends on the healthcare provider's preference and clinical situation.

5. A nurse at an antepartum clinic is caring for a client who is at 4 months of gestation. The client reports continued nausea, vomiting, and scant, prune-colored discharge. The client has experienced no weight loss and has a fundal height larger than expected. Which of the following complications should the nurse suspect?

• A. Hyperemesis gravidarum
• B. Threatened abortion
• C. Hydatidiform mole
• D. Preterm labor

Correct answer: C

Rationale: In this scenario, the symptoms of continued nausea, vomiting, scant prune-colored discharge, and a fundal height larger than expected at 4 months of gestation suggest a possible hydatidiform mole. Hyperemesis gravidarum (choice A) typically presents with severe nausea, vomiting, weight loss, and electrolyte imbalances. Threatened abortion (choice B) is characterized by vaginal bleeding with or without cramping but does not typically present with prune-colored discharge. Preterm labor (choice D) manifests with regular uterine contractions leading to cervical changes and can occur later in pregnancy.

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