Nursing Elites

1. A client who is postpartum has a slightly boggy and displaced fundus to the right. Which of the following actions should the nurse take based on these findings?

• A. Encourage the client to perform Kegel exercises.
• B. Encourage the client to move to the left lateral position.
• C. Ask the client to rate her pain.
• D. Assist the client to the bathroom to void.

Correct answer: D

Rationale: A displaced and boggy fundus in a postpartum client typically indicates a full bladder, which can impede uterine contractions and increase the risk of postpartum hemorrhage. Assisting the client to the bathroom to void helps ensure the bladder is empty, aiding the fundus to contract and reducing the risk of complications. Encouraging Kegel exercises, changing positions, or assessing pain would not directly address the issue of the boggy fundus caused by a full bladder.

2. A newborn was delivered vaginally and experienced a tight nuchal cord. Which of the following clinical manifestations should the nurse expect to observe?

• A. Bruising over the buttocks
• B. Hard nodules on the roof of the mouth
• C. Petechiae over the head
• D. Bilateral periauricular papillomas

Correct answer: C

Rationale: When a newborn experiences a tight nuchal cord during delivery, it can lead to petechiae, which are small red or purple spots on the skin caused by bleeding under the skin. These petechiae may appear over the head, face, and neck due to the pressure of the cord. It is essential for the nurse to recognize this as a possible consequence and monitor the newborn for any signs of complications. Bruising over the buttocks (Choice A) is not typically associated with a tight nuchal cord. Hard nodules on the roof of the mouth (Choice B) are more indicative of Epstein pearls or Bohn's nodules, which are considered normal findings in newborns. Bilateral periauricular papillomas (Choice D) are not related to a tight nuchal cord but are seen in congenital syphilis.

3. When reviewing postpartum nutrition needs with breastfeeding clients, which statement indicates an understanding of the teaching?

• A. I am glad I can have my morning coffee.
• B. I should take folic acid to increase my milk supply.
• C. I will continue adding 330 calories per day to my diet.
• D. I will continue my calcium supplements because I don't like milk.

Correct answer: D

Rationale: The correct answer is D. Clients who do not like milk should continue taking calcium supplements to ensure they meet their increased calcium needs while breastfeeding. Calcium is essential for bone health, and during breastfeeding, the mother's calcium requirements are higher. While caffeine in coffee can be consumed in moderation, folic acid does not directly impact milk supply, and the additional 330 calories per day are recommended but not the focus of this question.

4. A healthcare professional is preparing to administer prophylactic eye ointment to a newborn to prevent ophthalmia neonatorum. Which of the following medications should the healthcare professional anticipate administering?

• A. Ofloxacin
• B. Nystatin
• C. Erythromycin
• D. Ceftriaxone

Correct answer: C

Rationale: Erythromycin eye ointment is the medication of choice for preventing ophthalmia neonatorum, an eye infection in newborns caused by exposure to gonorrhea or chlamydia during birth. Erythromycin helps prevent the transmission of these bacteria from the mother to the baby during delivery, protecting the newborn's eyes from potential infection. Ofloxacin, Nystatin, and Ceftriaxone are not indicated for preventing ophthalmia neonatorum. Ofloxacin is a fluoroquinolone antibiotic used for treating eye infections in adults, Nystatin is an antifungal medication used for fungal infections, and Ceftriaxone is a cephalosporin antibiotic used for various bacterial infections, but not for preventing ophthalmia neonatorum.

5. A client is reinforcing discharge teaching with a client who has premature rupture of membranes at 26 weeks of gestation. Which of the following instructions should the client include?

• A. Use a condom with sexual intercourse
• B. Avoid bubble bath solution when taking a tub bath
• C. Wipe from front to back when performing perineal hygiene
• D. Keep a daily record of fetal kick counts

Correct answer: D

Rationale: Keeping a daily record of fetal kick counts is crucial for clients with premature rupture of membranes at 26 weeks of gestation as it helps monitor fetal well-being. This activity enables the client to assess the frequency and strength of fetal movements, which can provide important information about the fetus' health and development. Other options such as using a condom with sexual intercourse, avoiding bubble bath solution, and wiping from front to back are important for general perinatal care but are not specifically related to managing premature rupture of membranes.

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