Nursing Elites

1. A healthcare provider is assessing a newborn who has a coarctation of the aorta. Which of the following should the provider recognize as a clinical manifestation of coarctation of the aorta?

• A. Increased blood pressure in the arms with decreased blood pressure in the legs
• B. Decreased blood pressure in the arms with increased blood pressure in the legs
• C. Increased blood pressure in both the arms and the legs
• D. Decreased blood pressure in both the arms and the legs

Correct answer: A

Rationale: The correct answer is increased blood pressure in the arms with decreased blood pressure in the legs. Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities due to decreased blood flow beyond the narrowing. Choice B is incorrect because coarctation of the aorta does not lead to increased blood pressure in the legs. Choice C is incorrect because increased blood pressure in both the arms and legs is not a typical manifestation of coarctation of the aorta. Choice D is incorrect because decreased blood pressure in both the arms and legs is not characteristic of coarctation of the aorta.

2. A client has a new prescription for chlamydia. Which of the following statements should the nurse provide?

• A. This infection is treated with one dose of azithromycin.
• B. If your sexual partner has no symptoms, no medication is needed.
• C. You should avoid sexual relations for 3 days.
• D. You need to return in 6 months for retesting.

Correct answer: A

Rationale: The correct treatment for chlamydia is a one-time dose of azithromycin. It is crucial for the client to understand the correct medication regimen for effective treatment. Choice B is incorrect because treatment is necessary for the partner even if asymptomatic. Choice C is incorrect because sexual relations should be avoided until treatment is completed. Choice D is incorrect as retesting should generally occur 3 months after treatment.

3. A nurse on the labor and delivery unit is caring for a client who is having a difficult, prolonged labor with severe backache. Which of the following contributing causes should the nurse identify?

• A. Fetal attitude is in general flexion.
• B. Fetal lie is longitudinal.
• C. Maternal pelvis is gynecoid.
• D. Fetal position is persistent occiput posterior.

Correct answer: D

Rationale: The correct answer is D. In a persistent occiput posterior position, the baby's head presses against the mother's spine, causing prolonged labor and severe backache. This position can lead to difficulties in labor progress and increase discomfort for the mother. Choices A, B, and C are incorrect as they do not directly relate to the client's difficult, prolonged labor with severe backache. Fetal attitude, fetal lie, and maternal pelvis type may affect labor, but in this scenario, the persistent occiput posterior fetal position is the primary contributing cause for the client's symptoms.

4. When monitoring uterine contractions in a client in the active phase of the first stage of labor, which finding should the nurse report to the provider?

• A. Contractions lasting longer than 90 seconds
• B. Contractions occurring every 3 to 5 minutes
• C. Contractions are strong in intensity
• D. Client reports feeling contractions in the lower back

Correct answer: A

Rationale: During the active phase of the first stage of labor, contractions lasting longer than 90 seconds can indicate uterine hyperstimulation, leading to decreased placental perfusion and fetal oxygenation. This finding should be reported to the provider for further evaluation and management. Choices B, C, and D are not the priority findings in this scenario. Contractions occurring every 3 to 5 minutes are within the normal range for the active phase of labor. Strong contractions and feeling contractions in the lower back are common experiences during labor and not necessarily concerning unless associated with other complications.

5. A client who is at 6 weeks of gestation with her first pregnancy asks the nurse when she can expect to experience quickening. Which of the following responses should the nurse make?

• A. This will occur during the last trimester of pregnancy.
• B. This will happen by the end of the first trimester of pregnancy.
• C. This will occur between the fourth and fifth months of pregnancy.
• D. This will happen once the uterus begins to rise out of the pelvis.

Correct answer: C

Rationale: Quickening, which is the first perception of fetal movements by the mother, typically occurs between the fourth and fifth months of pregnancy, around 18-20 weeks of gestation. Choice C is correct as it provides the client with accurate information about the expected timing of this significant milestone in her pregnancy. Choices A, B, and D are incorrect because quickening does not happen during the last trimester, by the end of the first trimester, or once the uterus begins to rise out of the pelvis. The correct timeframe for quickening is during the second trimester, specifically between the fourth and fifth months.

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