Nursing Elites

1. A client who is receiving prenatal care is at her 24-week appointment. Which of the following laboratory tests should the nurse plan to conduct?

• A. Group B strep culture
• B. 1-hour glucose tolerance test
• C. Rubella titer
• D. Blood type and Rh

Correct answer: B

Rationale: The correct answer is B: 1-hour glucose tolerance test. At around 24-28 weeks of gestation, a pregnant individual is typically screened for gestational diabetes. The 1-hour glucose tolerance test helps in identifying elevated blood sugar levels during pregnancy. Choice A, Group B strep culture, is not typically performed at the 24-week appointment but later in the third trimester to screen for Group B streptococcus colonization. Choice C, Rubella titer, is usually checked early in pregnancy to determine immunity to rubella. Choice D, Blood type and Rh, is important for determining the client's blood type and Rh status, but it is usually done earlier in pregnancy and not specifically at the 24-week appointment.

2. When should a nurse on a labor and delivery unit instruct a newly licensed nurse to don gloves for a procedure?

• A. Assisting a mother with breastfeeding
• B. Performing a newborn's initial bath
• C. Administering the measles, mumps, rubella vaccine
• D. Performing umbilical cord care

Correct answer: B

Rationale: The correct answer is B: Performing a newborn's initial bath. Gloves should be worn during this procedure to protect against exposure to body fluids, such as amniotic fluid or blood. Assisting a mother with breastfeeding (Choice A) does not typically require gloves unless there are specific reasons for infection control. Administering vaccines (Choice C) and performing umbilical cord care (Choice D) are procedures that may require hand hygiene but not necessarily gloves, unless there is active bleeding or potential exposure to body fluids. The initial bath involves direct contact with body fluids, making it crucial to wear gloves for protection.

3. A new mother who is a lacto-ovo vegetarian plans to breastfeed her infant. Which information should the nurse provide prior to discharge?

• A. Continue prenatal vitamins with B12 while breastfeeding
• B. Avoid using Lanolin-based nipple cream or ointment
• C. Offer iron-fortified supplemental formula daily
• D. Weigh the baby weekly to evaluate the newborn's growth

Correct answer: A

Rationale: The correct answer is A: 'Continue prenatal vitamins with B12 while breastfeeding.' Vitamin B12 is crucial for lacto-ovo vegetarian mothers to prevent deficiencies in both the mother and the infant. Choice B is incorrect as Lanolin-based nipple cream is safe for use during breastfeeding. Choice C is not necessary unless there are specific indications for iron supplementation. Choice D, weighing the baby weekly, is important for monitoring growth but not specifically related to the mother's diet.

4. A client who is 5 days postpartum is being taught about signs of effective breastfeeding. Which information should the nurse include in the teaching?

• A. Feeling a tugging sensation when the baby is sucking
• B. Expecting the baby to have two to three wet diapers in a 24-hour period
• C. The baby’s urine should appear dark and concentrated
• D. The breast should stay firm after the baby breastfeeds

Correct answer: A

Rationale: Feeling a tugging sensation while the baby is sucking indicates an effective latch and milk transfer during breastfeeding. This sensation means that the baby is effectively drawing milk from the breast. Choice B is incorrect because infants should ideally have six to eight wet diapers in a 24-hour period to show adequate hydration. Choice C is incorrect as a dark and concentrated urine may indicate dehydration, which is not a sign of effective breastfeeding. Choice D is incorrect as the breast should soften after the baby breastfeeds, indicating that the baby has effectively emptied the breast of milk.

5. A client at 34 weeks gestation comes to the birthing center complaining of vaginal bleeding that began one hour ago. The nurse's assessment reveals approximately 30ML of bright red vaginal bleeding, fetal heart rate of 130 - 140 beats per minute, no contractions, and no complaints of pain. What is the most likely cause of this client's bleeding?

• A. Abruptio Placenta
• B. Placenta Previa
• C. Normal bloody show indicating induction of labor
• D. A ruptured blood vessel in the vaginal vault

Correct answer: B

Rationale: Placenta previa, a condition where the placenta covers the cervix, can cause painless, bright red vaginal bleeding in the third trimester. In this scenario, the absence of contractions and pain, along with the presence of significant bright red bleeding, is more indicative of placenta previa rather than abruptio placenta or a ruptured vessel. A normal bloody show typically occurs closer to the onset of labor and is not associated with the amount of bleeding described in the question.

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