Nursing Elites

1. A client is 4 hours postpartum and is experiencing hypovolemic shock. Which of the following actions should the nurse take?

• A. Administer indomethacin
• B. Insert a second 22-gauge IV catheter.
• C. Insert an indwelling urinary catheter.
• D. Administer oxygen at 4L/min via nasal cannula.

Correct answer: D

Rationale: In hypovolemic shock, there is decreased oxygen delivery to tissues. Administering oxygen at 4L/min via nasal cannula can help improve oxygenation and support tissue perfusion. Indomethacin (Choice A) is a nonsteroidal anti-inflammatory drug and is not indicated in the management of hypovolemic shock. Inserting a second 22-gauge IV catheter (Choice B) may be necessary for fluid resuscitation, but oxygen administration takes precedence. Inserting an indwelling urinary catheter (Choice C) may be considered for monitoring urinary output, but it is not the priority action in managing hypovolemic shock.

2. A client in labor requests nonpharmacological pain management. Which of the following nursing actions promotes client comfort?

• A. Assisting the client into a squatting position
• B. Having the client lie in a supine position
• C. Applying fundal pressure during contractions
• D. Encouraging the client to void every 6 hours

Correct answer: A

Rationale: Assisting the client into a squatting position promotes comfort during labor. This position can help relieve pain by utilizing gravity, allowing the pelvic outlet to widen, and potentially facilitating the progress of labor. Lying in a supine position (Choice B) can hinder labor progression and increase discomfort. Applying fundal pressure (Choice C) can be inappropriate and may cause harm as it is not routinely recommended during labor. Encouraging the client to void every 6 hours (Choice D) is important for bladder management but does not directly address pain relief during labor.

3. A primigravida is being monitored at the prenatal clinic for preeclampsia. Which finding is of greatest concern to the nurse?

• A. Blood pressure (BP) increased to 138/86 mm Hg.
• B. Weight gain of 0.5 kg during the past 2 weeks.
• C. Dipstick value of 3+ for protein in her urine.
• D. Pitting pedal edema at the end of the day.

Correct answer: C

Rationale: The correct answer is C. Proteinuria, indicated by a dipstick value of 3+ in the urine, is a significant concern in a patient being monitored for preeclampsia. Proteinuria is a key diagnostic criterion for preeclampsia, and a value of 3+ signifies a substantial amount of protein in the urine, warranting further evaluation. While an increase in blood pressure to 138/86 mm Hg is slightly elevated, it does not meet the diagnostic threshold for severe hypertension in preeclampsia. A weight gain of 0.5 kg over 2 weeks is within normal limits and not as concerning as significant rapid weight gain. Pitting pedal edema, though common in pregnancy, is not a specific indicator of preeclampsia and is considered a less concerning finding compared to significant proteinuria.

4. Which of the following statements is true of sickle-cell anemia?

• A. It is typically managed with treatments such as pain relief medications.
• B. It is caused by a mutation in the beta-globin gene.
• C. It leads to the obstruction of small blood vessels and decreased oxygen delivery.
• D. It is more prevalent in individuals of African, Mediterranean, Middle Eastern, and Indian descent.

Correct answer: C

Rationale: The correct answer is C. Sickle-cell anemia results from a mutation in the beta-globin gene, causing red blood cells to become sickle-shaped. These misshapen cells can obstruct small blood vessels, leading to reduced oxygen delivery to tissues. Choices A, B, and D are incorrect because sickle-cell anemia is typically managed with treatments such as pain relief medications, hydration, and in severe cases, blood transfusions. It is caused by a specific mutation in the beta-globin gene, not by the inability to metabolize phenylalanine. Additionally, sickle-cell anemia is more prevalent in individuals of African, Mediterranean, Middle Eastern, and Indian descent, not exclusive to any specific gender.

5. A client who has mild preeclampsia and will be caring for herself at home during the last 2 months of pregnancy is receiving teaching from a healthcare provider. Which statement by the client indicates an understanding of the teaching?

• A. “I will count baby’s kicks every other day.”
• B. “I will alternate the arm used to check my blood pressure.”
• C. “I will consume 50 grams of protein daily.”
• D. ---

Correct answer: B

Rationale: The correct answer is B. Alternating arms for blood pressure checks ensures more accurate readings and helps monitor preeclampsia. Option A, counting baby's kicks every other day, is not specific to managing preeclampsia. Option C, consuming 50 grams of protein daily, is important for a healthy diet during pregnancy but does not directly relate to preeclampsia management.

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