Nursing Elites

1. A nurse is caring for a client who is pregnant for the fourth time. The client delivered two full-term newborns and had one spontaneous abortion at 10 weeks of gestation. The nurse should document the client's obstetrical history as which of the following?

• A. Gravida 3, Para 2
• B. Gravida 3, Para 3
• C. Gravida 4, Para 2
• D. Gravida 4, Para 3

Correct answer: D

Rationale: Gravida refers to the total number of pregnancies (4), and Para refers to the number of viable births (2 full-term births). The client has had 4 pregnancies (Gravida 4) and delivered 2 full-term newborns (Para 2). The spontaneous abortion does not count as a viable birth, so the correct documentation is Gravida 4, Para 2. Choice A is incorrect because it does not account for the full obstetrical history. Choice B is incorrect as the client has not had 3 viable births. Choice C is incorrect as it does not reflect the number of viable births correctly.

2. A healthcare provider is assessing a newborn who is 48 hours old and is experiencing opioid withdrawals. Which of the following findings should the healthcare provider expect?

• A. Hypotonia
• B. Moderate tremors of the extremities
• C. Axillary temperature 36.1°C (96.9°F)
• D. Excessive crying

Correct answer: B

Rationale: The correct answer is B: Moderate tremors of the extremities. In newborns experiencing opioid withdrawals, moderate tremors of the extremities are a common sign. Other signs of opioid withdrawal in newborns may include irritability, feeding difficulties, and gastrointestinal disturbances. Choice A, hypotonia, is not typically associated with opioid withdrawal in newborns. Choice C, an axillary temperature of 36.1°C (96.9°F), falls within the normal range for newborns and is not specifically indicative of opioid withdrawal. Choice D, excessive crying, is not a typical sign of opioid withdrawal in newborns.

3. While caring for a client in active labor, a nurse notes late decelerations in the FHR on the external fetal monitor. Which of the following actions should the nurse take first?

• A. Change the client's position
• B. Palpate the uterus to assess for tachysystole
• C. Increase the client's IV infusion rate
• D. Administer oxygen at 10 L/min via nonrebreather mask

Correct answer: A

Rationale: The correct initial action for the nurse to take is to change the client's position. This intervention can alleviate pressure on the umbilical cord, potentially improving fetal oxygenation and addressing the underlying cause of late decelerations. Palpating the uterus to assess for tachysystole or increasing the IV infusion rate are not the first-line interventions for addressing late decelerations. Administering oxygen at a high flow rate via a nonrebreather mask may be necessary but is not the priority action in this situation.

4. A client has been prescribed trazodone. Which of the following should be monitored?

• A. Blood glucose levels
• B. Liver function
• C. Mood changes
• D. Heart rate

Correct answer: C

Rationale: Correct. Trazodone is an antidepressant that can impact mood and behavior. Monitoring for changes in mood or behavior is crucial to assess the effectiveness and potential side effects of the medication. Monitoring blood glucose levels is not typically associated with trazodone use. While trazodone can affect liver function in some cases, monitoring liver function is not the primary concern compared to assessing mood changes. Trazodone can cause changes in heart rate in some patients, but the priority monitoring in this case should be related to its effects on mood.

5. A client with heart failure who presents with dyspnea, bibasilar crackles, and frothy sputum should receive which dietary recommendation?

• A. Decrease protein intake.
• B. Reduce sodium intake.
• C. Increase fluid intake.
• D. Decrease calcium intake.

Correct answer: B

Rationale: The correct answer is to reduce sodium intake. In heart failure, excess sodium can lead to fluid retention, exacerbating symptoms like dyspnea, bibasilar crackles, and frothy sputum. Therefore, reducing sodium intake is crucial in managing heart failure. Decreasing protein intake is not typically recommended in heart failure management. Increasing fluid intake would worsen the condition by further contributing to fluid overload. Decreasing calcium intake is not directly related to managing heart failure symptoms such as dyspnea, bibasilar crackles, and frothy sputum.

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