Nursing Elites

1. A nurse is caring for a laboring client and notes that the fetal heart rate begins to decelerate after the contraction has started. The lowest point of deceleration occurs after the peak of the contraction. What is the priority nursing action?

• A. Administer oxygen
• B. Change the client's position
• C. Increase IV fluids
• D. Call the healthcare provider

Correct answer: B

Rationale: Late decelerations are caused by uteroplacental insufficiency, indicating that the fetus is not receiving adequate oxygen during contractions. This is an emergency that requires prompt intervention. Changing the client's position helps improve placental blood flow, reducing stress on the fetus. Administering oxygen may be necessary if changing position does not resolve the decelerations. Increasing IV fluids is not the priority in this situation as it won't directly address the cause of late decelerations. Calling the healthcare provider should be done after immediate interventions like changing the client's position have been implemented and assessed.

2. A client is experiencing suicidal thoughts and states, 'Why not end my misery?' What is the best response by the nurse?

• A. Why do you think your life isn’t worth living anymore?
• B. Do you have a plan to end your life?
• C. I need to understand what you mean by misery.
• D. You can trust me to share your thoughts.

Correct answer: B

Rationale: The correct answer is B: 'Do you have a plan to end your life?' When a client expresses suicidal thoughts, it is crucial to assess the immediate risk. Inquiring about a specific plan can help determine the seriousness of the situation. Choice A is less direct and may not provide a clear indication of the immediate risk. Choice C focuses on the interpretation of 'misery' rather than assessing the risk of suicide. Choice D offers support but does not address the critical assessment of the client's immediate safety.

3. A nurse in an urgent-care clinic is collecting admission history from a client who is 16 weeks gestation and has bacterial vaginosis. The nurse should recognize that which of the following clinical findings are associated with this infection?

• A. Frequency and dysuria
• B. Profuse milky white discharge
• C. Hematuria
• D. Low-grade fever

Correct answer: B

Rationale: Bacterial vaginosis often presents with a profuse, milky white discharge and a characteristic fishy odor, without significant inflammation, hematuria, or fever. Choice A, frequency, and dysuria are more indicative of a urinary tract infection. Choice C, hematuria, is associated with conditions like urinary tract infections or kidney problems. Choice D, low-grade fever, is not a typical symptom of bacterial vaginosis.

4. A client has been prescribed amlodipine for hypertension. Which of the following adverse effects should the nurse instruct the client to report?

• A. Dry cough
• B. Dizziness
• C. Rash
• D. Headache

Correct answer: B

Rationale: The correct answer is B: 'Dizziness.' Amlodipine, a calcium channel blocker used for hypertension, can cause dizziness due to its blood pressure-lowering effects. It is crucial for clients to report dizziness to their healthcare provider as it may indicate hypotension. Dry cough (choice A) is more commonly associated with ACE inhibitors, rash (choice C) may be seen in allergic reactions, and headache (choice D) is a less common side effect of amlodipine.

5. A provider has written a do not resuscitate (DNR) order for a client who is comatose and does not have advance directives. A member of the client’s family says, 'I wonder when the doctor will tell us what’s going on.' Which of the following actions should the nurse take first?

• A. Request that the provider provide more information to the family.
• B. Refer the family to a support group for grief counseling.
• C. Offer to answer questions that family members have.
• D. Ask the family what the provider has discussed with them.

Correct answer: D

Rationale: The correct action for the nurse to take first is to ask the family what the provider has discussed with them. This allows the nurse to clarify any misunderstandings and ensures that the family is fully informed before providing further information. Option A is not the best choice because it assumes the need for more information without first understanding what has already been communicated. Option B is premature as the family may not be ready for grief counseling at this stage. Option C, although a good general practice, is not the most appropriate immediate action in this situation where clarifying existing information is crucial.

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