Nursing Elites

1. A client who is at 42 weeks gestation and in labor asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make?

• A. Your baby will have excess baby fat.
• B. Your baby will have flat areola without breast buds.
• C. Your baby's heels will easily move to his ears.
• D. Your baby's skin will have a leathery appearance.

Correct answer: D

Rationale: The correct answer is D: 'Your baby's skin will have a leathery appearance.' Postmature infants, born after 42 weeks of gestation, may have a leathery appearance of the skin due to prolonged exposure to amniotic fluid. This occurs as the protective vernix caseosa is shed, and the skin loses its protective covering, leading to a wrinkled and dry appearance. Choices A, B, and C are incorrect. Excess baby fat is not a typical characteristic of postmature infants. Flat areola without breast buds and the ability of the baby's heels to easily move to his ears are not associated with postmaturity.

2. When should a provider order a maternal serum alpha-fetoprotein (MSAFP) screening for pregnant clients?

• A. A client who has mitral valve prolapse
• B. A client who has been exposed to AIDS
• C. All pregnant clients
• D. A client who has a history of preterm labor

Correct answer: C

Rationale: Maternal serum alpha-fetoprotein (MSAFP) screening is recommended for all pregnant clients to assess the risk of neural tube defects. It is a routine screening test used to detect increased levels of alpha-fetoprotein in maternal blood, which may indicate a higher risk for conditions such as neural tube defects in the developing fetus. Therefore, all pregnant clients, regardless of their medical history or risk factors, should undergo MSAFP screening as part of routine prenatal care. Choices A, B, and D are incorrect because the MSAFP screening is not specific to certain medical conditions or histories; it is a standard screening procedure for all pregnant individuals to evaluate neural tube defect risk in the fetus.

3. A client who is at 15 weeks of gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure?

• A. Check the client's temperature.
• B. Observe for uterine contractions.
• C. Administer Rho(D) immune globulin.
• D. Monitor the fetal heart rate (FHR).

Correct answer: D

Rationale: After an amniocentesis, the priority nursing intervention is to monitor the fetal heart rate (FHR) as the greatest risk to the client and fetus is fetal death. This monitoring helps in early identification of any fetal distress or compromise, allowing prompt intervention to ensure fetal well-being. Checking the client's temperature (Choice A) is not the priority as monitoring the fetus is crucial for immediate assessment. Observing for uterine contractions (Choice B) is important but not the priority after an amniocentesis. Administering Rho(D) immune globulin (Choice C) is typically done to Rh-negative clients after procedures that may lead to fetal-maternal hemorrhage, not immediately after an amniocentesis.

4. A client at 8 weeks of gestation with iron deficiency anemia is prescribed iron supplements. Which beverage should the nurse reinforce the client to take the supplements with for better absorption?

• A. Ice water
• B. Low-fat or whole milk
• C. Tea or coffee
• D. Orange juice

Correct answer: D

Rationale: The correct answer is 'Orange juice.' Orange juice is recommended to be taken with iron supplements because vitamin C present in orange juice enhances iron absorption, improving the effectiveness of the supplement. It is essential to take iron supplements with a source of vitamin C to optimize iron absorption and address iron deficiency anemia. Ice water (Choice A), low-fat or whole milk (Choice B), and tea or coffee (Choice C) are not ideal choices to take with iron supplements as they do not contain vitamin C, which is crucial for enhancing iron absorption.

5. A newborn was transferred to the nursery 30 min after delivery. What should the nurse do first?

• A. Confirm the newborn's identification.
• B. Verify the newborn's identification.
• C. Administer vitamin K to the newborn.
• D. Determine obstetrical risk factors.

Correct answer: B

Rationale: When a newborn is transferred to the nursery, the first action the nurse should take is to verify the newborn's identification. This step is crucial for ensuring the correct care is provided to the right newborn, promoting patient safety and preventing errors. Administering vitamin K (Choice C) is important but should not be the first action. Determining obstetrical risk factors (Choice D) is not the priority when the newborn is transferred to the nursery. Confirming (Choice A) and verifying (Choice B) have similar meanings, but 'verify' is a more appropriate term in this context.

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