Nursing Elites

1. 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.

2. A healthcare professional is discussing risk factors for urinary tract infections with a newly licensed nurse. Which of the following conditions should the healthcare professional include in the teaching? (Select all that apply)

• A. Epidural anesthesia
• B. Urinary bladder catheterization
• C. Frequent pelvic examinations
• D. All of the Above

Correct answer: D

Rationale: Urinary tract infections can be influenced by various factors. Epidural anesthesia, urinary bladder catheterization, and frequent pelvic examinations are all associated with an increased risk of UTIs. Epidural anesthesia can introduce bacteria into the urinary tract, urinary bladder catheterization can serve as a pathway for bacteria to enter the bladder, and frequent pelvic examinations can disrupt the natural flora and introduce bacteria. Therefore, it is crucial for healthcare professionals to be aware of these risk factors to help prevent and manage UTIs effectively. Choice D, 'All of the Above,' is the correct answer as all the listed conditions are significant risk factors for urinary tract infections. Choices A, B, and C are incorrect because each of them, when present, can contribute to the development of UTIs. It is essential for healthcare professionals to educate patients and colleagues about these risk factors to minimize the occurrence of UTIs.

3. A client in an obstetrical clinic is discussing using an IUD for contraception with a healthcare provider. Which of the following statements by the client indicates an understanding of the teaching?

• A. An IUD should be replaced annually during a pelvic exam.
• B. I cannot get an IUD until after I've had a child.
• C. I should plan on regaining fertility 5 months after the IUD is removed.
• D. I will check to ensure the strings of the IUD are still present after my periods.

Correct answer: D

Rationale: Checking for the presence of IUD strings after each period is crucial to ensure the IUD is correctly positioned and functioning. This practice helps in confirming the effectiveness of the contraceptive method and timely detection of any displacement or issues with the IUD. Choice A is incorrect as IUDs have varying durations of effectiveness, but they do not need to be replaced annually as a routine. Choice B is incorrect as women can get an IUD even if they haven't had a child. Choice C is incorrect as fertility typically returns shortly after IUD removal, not necessarily after a specific timeframe like 5 months.

4. When educating a pregnant client about potential complications, which manifestation should the nurse emphasize reporting to the provider promptly?

• A. Vaginal bleeding
• B. Swelling of the ankles
• C. Heartburn after eating
• D. Lightheadedness when lying on back

Correct answer: A

Rationale: Vaginal bleeding during pregnancy is a concerning sign that could indicate serious complications like miscarriage or placental issues. Prompt reporting to the healthcare provider is crucial for timely evaluation and management to ensure the best outcomes for both the mother and the baby. Swelling of the ankles (choice B), heartburn after eating (choice C), and lightheadedness when lying on the back (choice D) are common discomforts during pregnancy but are not typically associated with serious complications that require immediate attention.

5. A client who is pregnant and has phenylketonuria (PKU) is receiving teaching from a nurse. Which of the following foods should the nurse instruct the client to eliminate from her diet?

• A. Peanut butter
• B. Potatoes
• C. Apple juice
• D. Broccoli

Correct answer: A

Rationale: Individuals with phenylketonuria (PKU) have difficulty breaking down phenylalanine, an amino acid found in protein-rich foods like peanut butter. Therefore, clients with PKU should avoid foods high in phenylalanine, such as peanut butter, to prevent adverse effects on their health. Choices B, C, and D are not typically high in phenylalanine and do not pose the same risk to individuals with PKU as peanut butter.

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