Nursing Elites

1. A healthcare provider is discussing the differences between true labor and false labor with a group of expectant parents. Which of the following characteristics should the healthcare provider include when discussing true labor?

• A. Contractions become stronger with walking.
• B. Discomfort can be relieved with a back massage.
• C. Contractions become irregular with a change in activity.
• D. Discomfort is felt above the umbilicus.

Correct answer: A

Rationale: During true labor, contractions typically become stronger and more regular with activity, such as walking. This is a key characteristic that helps differentiate true labor from false labor. In false labor, contractions often remain irregular and do not intensify with changes in activity. Choice B is incorrect because discomfort in true labor is not typically relieved with a back massage. Choice C is incorrect as contractions in true labor become stronger and more regular with activity rather than irregular. Choice D is incorrect because discomfort in true labor is usually felt in the lower abdomen and pelvis, not above the umbilicus.

2. A client is to receive oxytocin to augment labor. Which finding contraindicates the initiation of the oxytocin infusion and should be reported to the provider?

• A. Late decelerations
• B. Moderate variability of the FHR
• C. Cessation of uterine dilation
• D. Prolonged active phase of labor

Correct answer: A

Rationale: Late decelerations are indicative of uteroplacental insufficiency, which can be exacerbated by oxytocin administration, potentially compromising fetal well-being. Therefore, detecting late decelerations should prompt immediate reporting to the provider to prevent harm to the fetus. Choices B, C, and D are not contraindications for initiating oxytocin infusion. Moderate variability of the FHR is a reassuring sign of fetal well-being, cessation of uterine dilation may indicate a pause in labor progress but does not contraindicate oxytocin, and prolonged active phase of labor may necessitate oxytocin administration to augment contractions and progress labor.

3. A client is in labor and reports increasing rectal pressure. She is experiencing contractions 2 to 3 minutes apart, each lasting 80 to 90 seconds, and a vaginal examination reveals that her cervix is dilated to 9 cm. The client is in which of the following phases of labor?

• A. Active
• B. Transition
• C. Latent
• D. Descent

Correct answer: B

Rationale: The client is in the transition phase of labor, characterized by cervical dilatation of 8 to 10 cm and contractions every 2 to 3 minutes, each lasting 45 to 90 seconds. In this phase, the cervix is nearly fully dilated, preparing the client for the pushing stage. The active phase of labor typically involves cervical dilatation from 4 to 7 cm, whereas the latent phase is the early phase of labor when the cervix dilates from 0 to 3 cm. Descent is not a phase of labor but rather refers to the movement of the fetus through the birth canal during the second stage of labor.

4. A client has postpartum psychosis. Which of the following actions is the nurse's priority?

• A. Reinforce the importance of taking antipsychotics as prescribed
• B. Ask the client if they have thoughts of harming themselves or their infant
• C. Monitor the infant for signs of failure to thrive
• D. Check the client's medical record for a history of bipolar disorder

Correct answer: B

Rationale: In a situation where a client has postpartum psychosis, the priority action for the nurse is to ask the client if they have thoughts of harming themselves or their infant. This is crucial to assess the risk of harm and ensure the safety of the client and the infant. While reinforcing the importance of taking antipsychotics as prescribed is essential for treatment, safety concerns take precedence. Monitoring the infant for signs of failure to thrive is important for the infant's well-being but is not the priority when the immediate safety of the client and infant is at risk. Checking the client's medical record for a history of bipolar disorder is relevant for understanding the client's medical history but is not the priority when addressing current safety concerns.

5. A client at 36 weeks of gestation is suspected of having placenta previa. Which of the following findings support this diagnosis?

• A. Painless red vaginal bleeding
• B. Increasing abdominal pain with a non-relaxed uterus
• C. Abdominal pain with scant red vaginal bleeding
• D. Intermittent abdominal pain following the passage of bloody mucus

Correct answer: A

Rationale: Painless red vaginal bleeding is a hallmark sign of placenta previa. In this condition, the placenta partially or completely covers the cervical opening, leading to painless, bright red bleeding due to the separation of the placenta from the uterine wall. Other types of bleeding, such as those associated with abdominal pain or mucus passage, are more indicative of conditions like placental abruption rather than placenta previa. Therefore, choices B, C, and D are incorrect as they describe findings more consistent with placental abruption rather than placenta previa.

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