Nursing Elites

1. A client has severe preeclampsia and is receiving magnesium sulfate IV. Which of the following findings should the nurse identify and report as signs of magnesium sulfate toxicity? (Select all that apply)

• A. Respirations less than 12/min
• B. Urinary output less than 25 mL/hr
• C. Decreased level of consciousness
• D. All of the above

Correct answer: D

Rationale: Signs of magnesium sulfate toxicity include respirations less than 12/min, urinary output less than 25 mL/hr, and decreased level of consciousness. These signs indicate potential overdose of magnesium sulfate and require immediate attention to prevent further complications. Reporting these signs promptly is crucial to ensure the client's safety and well-being. Choice D, 'All of the above,' is the correct answer as all the listed findings are indicative of magnesium sulfate toxicity. Choices A, B, and C individually represent different signs of toxicity, making them incorrect on their own. Therefore, the nurse should be vigilant in identifying and reporting all these signs to prevent adverse outcomes.

2. A client at 11 weeks of gestation reports slight occasional vaginal bleeding over the past 2 weeks. After an examination, the provider informs the client that the fetus has died, and the placenta, fetus, and tissues remain in the uterus. How should the nurse document these findings?

• A. Incomplete miscarriage
• B. Missed miscarriage
• C. Inevitable miscarriage
• D. Complete miscarriage

Correct answer: B

Rationale: The correct answer is B: 'Missed miscarriage.' In a missed miscarriage, fetal and placental tissues are retained in the uterus after fetal demise, which matches the scenario described in the question. This situation often requires medical or surgical intervention to remove the remaining products of conception and prevent complications. 'Incomplete miscarriage' (Choice A) typically involves partial expulsion of products of conception, 'Inevitable miscarriage' (Choice C) indicates that miscarriage is in progress and cannot be stopped, and 'Complete miscarriage' (Choice D) signifies that all products of conception have been expelled from the uterus.

3. A client at 32 weeks of gestation with placenta previa is actively bleeding. Which medication should the provider likely prescribe?

• A. Betamethasone
• B. Indomethacin
• C. Nifedipine
• D. Methylergonovine

Correct answer: A

Rationale: In cases of placenta previa with active bleeding at 32 weeks of gestation, Betamethasone is prescribed to accelerate fetal lung maturity in anticipation of potential preterm delivery. This medication helps in reducing the risk of respiratory distress syndrome in the newborn, which is crucial in managing such high-risk pregnancies. Indomethacin is a nonsteroidal anti-inflammatory drug not indicated in this scenario and may be contraindicated due to its effects on platelet function and potential risk of bleeding. Nifedipine is a calcium channel blocker used for conditions like preterm labor or hypertension, not specifically for placenta previa with active bleeding. Methylergonovine is a uterotonic drug used to prevent or control postpartum hemorrhage, not indicated for placenta previa with active bleeding.

4. A caregiver is being taught about bottle feeding a newborn. Which of the following statements by the caregiver indicates a need for further instruction?

• A. I will keep the baby's head elevated while feeding.
• B. I will allow the baby to burp several times during each feeding.
• C. I will tilt the bottle to prevent air from entering as the baby sucks.
• D. My baby will have soft, formed yellow stools.

Correct answer: C

Rationale: Tilting the bottle to prevent air from entering as the baby sucks can lead to the baby swallowing air, causing discomfort and potential issues like colic or gas. The correct way to bottle-feed a newborn is by ensuring that the nipple is always filled with milk to avoid air intake, which can lead to problems. Keeping the baby's head elevated while feeding helps prevent choking, allowing the baby to burp several times during each feeding helps release swallowed air, and soft, formed yellow stools indicate a healthy digestion process in newborns.

5. A client who is at 22 weeks of gestation reports concern about the blotchy hyperpigmentation on her forehead. Which of the following actions should the nurse take?

• A. Tell the client to follow up with a dermatologist.
• B. Explain to the client this is an expected occurrence.
• C. Instruct the client to increase her intake of vitamin D.
• D. Inform the client she might have an allergy to her skin care products.

Correct answer: B

Rationale: Chloasma, also known as the mask of pregnancy, is a blotchy, brown hyperpigmentation of the skin over the cheeks, nose, and forehead. It is most common in dark-skinned women and is caused by an increase in melanotropin during pregnancy. This condition typically appears after 16 weeks of gestation and gradually increases until delivery for 50 to 70% of women. The nurse should reassure the client that this is an expected occurrence, which usually fades after delivery. Therefore, explaining to the client that this is an expected occurrence is the appropriate action in this situation. Options A, C, and D are incorrect because chloasma is a common skin change during pregnancy and does not require a referral to a dermatologist, an increase in vitamin D intake, or suspicion of an allergy to skin care products.

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