Nursing Elites

1. A client at 36 weeks of gestation is suspected of having placenta previa. Which of the following findings support this diagnosis?

• A. Painless red vaginal bleeding
• B. Increasing abdominal pain with a non-relaxed uterus
• C. Abdominal pain with scant red vaginal bleeding
• D. Intermittent abdominal pain following the passage of bloody mucus

Correct answer: A

Rationale: Painless red vaginal bleeding is a hallmark sign of placenta previa. In this condition, the placenta partially or completely covers the cervical opening, leading to painless, bright red bleeding due to the separation of the placenta from the uterine wall. Other types of bleeding, such as those associated with abdominal pain or mucus passage, are more indicative of conditions like placental abruption rather than placenta previa. Therefore, choices B, C, and D are incorrect as they describe findings more consistent with placental abruption rather than placenta previa.

2. When caring for clients in a prenatal clinic, a nurse should report which client's weight gain to the provider?

• A. 1.8 kg (4 lb) weight gain in the first trimester
• B. 3.6 kg (8 lb) weight gain in the first trimester
• C. 6.8 kg (15 lb) weight gain in the second trimester
• D. 11.3 kg (25 lb) weight gain in the third trimester

Correct answer: B

Rationale: A weight gain of 3.6 kg (8 lb) in the first trimester is excessive and should be reported to the provider for further evaluation. Excessive weight gain in the first trimester can be a sign of potential issues that need monitoring and intervention to ensure the well-being of both the mother and the baby. Choices A, C, and D represent weight gains that are within normal ranges for the respective trimesters and do not raise immediate concerns for reporting to the provider.

3. A client who underwent an amniotomy is now in the active phase of the first stage of labor. Which of the following actions should the nurse implement with this client?

• A. Maintain the client in the lithotomy position.
• B. Perform vaginal examinations frequently.
• C. Remind the client to bear down with each contraction.
• D. Encourage the client to empty her bladder every 2 hours.

Correct answer: D

Rationale: Encouraging the client to empty her bladder every 2 hours is essential during labor to prevent bladder distention, which can hinder labor progress and cause discomfort. A distended bladder can also lead to potential complications such as uterine atony or increased risk of infection. Choice A is incorrect as maintaining the client in the lithotomy position is not necessary during the active phase of the first stage of labor and may not be comfortable for the client. Choice B is incorrect because performing vaginal examinations frequently can increase the risk of introducing infection and disrupt the natural progress of labor. Choice C is incorrect as bearing down with each contraction is typically reserved for the second stage of labor when the cervix is fully dilated, not during the active phase of the first stage.

4. A client with hyperemesis gravidarum is receiving dietary teaching. Which of the following statements by the client indicates an understanding of the teaching?

• A. I will eat foods that appeal to my taste instead of trying to balance my meals.
• B. I will avoid having a snack at bedtime.
• C. I will have 8 ounces of hot tea with each meal.
• D. I will pair my sweets with a starch instead of eating them alone.

Correct answer: A

Rationale: In hyperemesis gravidarum, where there is severe nausea and vomiting during pregnancy, it is essential for the client to eat foods that appeal to their taste to prevent further nausea. Balancing meals may not be a priority initially if the client is struggling to keep any food down. Choice B is unrelated to managing hyperemesis gravidarum. Choice C, having hot tea with each meal, may not necessarily address the issue of taste preferences. Choice D, pairing sweets with a starch, is not as relevant as choosing foods appealing to taste for managing hyperemesis gravidarum.

5. A client in the antepartum unit is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

• A. Placenta previa
• B. Prolapsed cord
• C. Incompetent cervix
• D. Abruptio placentae

Correct answer: D

Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall, which can cause continuous abdominal pain and vaginal bleeding. In this scenario, the client's symptoms of sudden abdominal pain and vaginal bleeding are indicative of abruptio placentae, which requires immediate medical attention to prevent potential complications for both the client and the fetus. Placenta previa is characterized by painless vaginal bleeding in the third trimester, not sudden abdominal pain. Prolapsed cord presents with visible umbilical cord protruding from the vagina and is not associated with abruptio placentae symptoms. Incompetent cervix typically manifests as painless cervical dilation in the second trimester, not sudden abdominal pain and bleeding as seen in abruptio placentae.

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