Nursing Elites

1. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Urine protein concentration of 200 mg/24 hr.
• B. Creatinine level of 0.8 mg/dL
• C. Hemoglobin level of 14.8 g/dL
• D. Platelet count of 60,000/mm3

Correct answer: D

Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.

2. What is the structure of deoxyribonucleic acid (DNA)?

• A. single spiral
• B. double helix
• C. sphere
• D. cube

Correct answer: B

Rationale: The correct answer is B: double helix. DNA is structured as a double helix, resembling a twisted ladder made up of two strands of nucleotides. Choice A, single spiral, is incorrect as DNA is not a single spiral structure. Choice C, sphere, is incorrect as DNA does not form a spherical shape. Choice D, cube, is incorrect as DNA does not have a cubic structure. Understanding the double helix structure of DNA is essential as it allows for the storage and transmission of genetic information in living organisms.

3. According to a study in 2014 by Skakkebaek et al., who among the following is most likely to have gynecomastia?

• A. Jennifer, a dancer, who has Down syndrome
• B. Frank, a teacher, who is diagnosed with XYY syndrome
• C. Peter, a fashion designer, who has Klinefelter syndrome
• D. Ria, a gym instructor, who is diagnosed with Turner syndrome

Correct answer: C

Rationale: Individuals with Klinefelter syndrome have an extra X chromosome (XXY) and typically have reduced testosterone levels, which can lead to gynecomastia (enlarged breasts). This condition is not usually associated with Down syndrome (choice A), XYY syndrome (choice B), or Turner syndrome (choice D), making them less likely to have gynecomastia.

4. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?

• A. Temperature 37.9°C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg.
• B. Temperature 37.4°C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg.
• C. Temperature 38°C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg.
• D. Temperature 36.8°C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg.

Correct answer: A

Rationale: An estimated blood loss (EBL) of 1500 ml following a vaginal birth is significant and can lead to hypovolemia. The vital signs provided in option A (Temperature 37.9°C, heart rate 120 bpm, respirations 20 breaths per minute, and blood pressure 90/50 mm Hg) indicate tachycardia and hypotension, which are concerning signs of hypovolemia due to excessive blood loss. Tachycardia is the body's compensatory mechanism to maintain cardiac output in response to decreased blood volume, and hypotension indicates inadequate perfusion. Options B, C, and D do not exhibit the same level of concern for hypovolemia. Option B shows tachypnea, which can be a result of pain or anxiety postpartum. Option C and D have vital signs within normal limits, which are not indicative of the body's response to significant blood loss.

5. At 31 weeks gestation, a client with a fundal height measurement of 25 cm is scheduled for a series of ultrasounds to be performed every two weeks. Which explanation should the nurse provide?

• A. Assessment for congenital anomalies
• B. Recalculation of gestational age
• C. Evaluation of fetal growth
• D. Determination of fetal presentation

Correct answer: C

Rationale: The correct answer is C: 'Evaluation of fetal growth.' A fundal height measurement smaller than expected may indicate intrauterine growth restriction (IUGR), requiring serial ultrasounds to monitor fetal growth. Assessing for congenital anomalies (choice A) is usually done through detailed anatomy scans earlier in pregnancy. Recalculating gestational age (choice B) is typically unnecessary at this stage unless there are concerns about accuracy. Determining fetal presentation (choice D) is usually done closer to term to plan for the mode of delivery.

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