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 nurse is assessing a client who has diabetes insipidus and is receiving desmopressin. Which of the following should the nurse monitor?

• A. Fasting blood glucose
• B. Carbohydrate intake
• C. Hematocrit
• D. Weight

Correct answer: D

Rationale: The correct answer is D: Weight. Desmopressin can cause fluid retention, so monitoring the client's weight is crucial to detect signs of water intoxication or overhydration, which can occur with the medication. Monitoring fasting blood glucose (choice A) is not directly related to desmopressin use in diabetes insipidus. Carbohydrate intake (choice B) is important for diabetes management but is not specifically relevant to monitoring desmopressin therapy. Hematocrit (choice C) is not typically influenced by desmopressin use in diabetes insipidus.

3. A client who is 8 hours postpartum asks the nurse if she will need to receive Rh immune globulin. The client is gravida 2, para 2, and her blood type is AB negative. The newborn’s blood type is B positive. Which of the following statements is appropriate?

• A. You only need to receive Rh immune globulin if you have a positive blood type.
• B. You should receive Rh immune globulin within 72 hours of delivery.
• C. Both you and your baby should receive Rh immune globulin at your 6-week appointment.
• D. Immune globulin is not necessary since this is your second pregnancy.

Correct answer: B

Rationale: The correct answer is B. Rh-negative mothers who give birth to an Rh-positive baby should receive Rh immune globulin within 72 hours of delivery to prevent the development of antibodies in future pregnancies. Choice A is incorrect because Rh-negative individuals are the ones who require Rh immune globulin. Choice C is incorrect as the administration of Rh immune globulin is time-sensitive and not typically scheduled for a 6-week appointment. Choice D is incorrect because Rh immune globulin is necessary to prevent sensitization regardless of the number of pregnancies.

4. A nurse is caring for a client prescribed the HMG CoA reductase inhibitor, atorvastatin. Which of the following should be monitored while this medication is prescribed?

• A. Liver function test
• B. Renal function test
• C. Hearing screenings
• D. Visual acuity screenings

Correct answer: A

Rationale: Corrected Rationale: Atorvastatin, an HMG CoA reductase inhibitor, can lead to hepatotoxicity. Therefore, monitoring liver function through regular tests is essential. Baseline liver function should be assessed, followed by tests at 12 weeks after starting therapy and periodically thereafter. This monitoring helps detect early signs of liver damage, including jaundice, nausea, and dark urine. Incorrect Choices Rationale: B) Renal function test is not directly affected by atorvastatin. C) Hearing screenings and D) Visual acuity screenings are not indicated for monitoring while on atorvastatin therapy.

5. A client prescribed allopurinol for gout is being taught by a nurse. Which of the following should be included in the teaching?

• A. Take the medication with meals.
• B. Drink at least 2 liters of water per day.
• C. Avoid foods high in purines.
• D. Increase your dietary intake of calcium.

Correct answer: B

Rationale: The correct answer is B: 'Drink at least 2 liters of water per day.' Clients taking allopurinol should be instructed to drink plenty of water to prevent kidney stones, a potential side effect of the medication. Option A is incorrect because allopurinol is usually taken without regard to meals. Option C is not directly related to the teaching about allopurinol, as it pertains more to dietary management of gout. Option D is also unrelated to allopurinol use for gout.

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