Nursing Elites

1. A healthcare provider is instructing a client who is taking an oral contraceptive about manifestations to report. Which of the following manifestations should the healthcare provider include?

• A. Reduced menstrual flow
• B. Breast tenderness
• C. Shortness of breath
• D. Increased appetite

Correct answer: C

Rationale: Shortness of breath is a symptom that can indicate a serious side effect of oral contraceptives, such as a potential blood clot in the lungs. This condition requires immediate medical attention to prevent complications. Choices A, B, and D are not typically associated with serious side effects of oral contraceptives and are considered normal or common side effects that do not require urgent medical attention.

2. A client in labor requests epidural anesthesia for pain control. Which of the following actions should the nurse include in the plan of care?

• A. Position the client supine for 30 minutes after the first dose of anesthetic solution.
• B. Administer 1,000 mL of dextrose 5% in water after the first dose of anesthetic solution.
• C. Monitor the client's blood pressure every 5 minutes after the first dose of anesthetic solution.
• D. Ensure the client has been NPO for 4 hours before the placement of the epidural and the first dose of anesthetic solution.

Correct answer: C

Rationale: The correct action is to monitor the client's blood pressure every 5 to 10 minutes following the first dose of anesthetic solution to assess for maternal hypotension. This is crucial to detect and manage potential complications associated with the epidural anesthesia. Positioning the client supine for a prolonged period can lead to hypotension; administering dextrose solution is not a standard practice in epidural anesthesia; ensuring NPO status for 4 hours is not necessary before epidural placement.

3. A patient on the labor and delivery unit is having induction of labor with oxytocin administered through a secondary IV line. Uterine contractions occur every 2 minutes, last 90 seconds, and are strong to palpation. The baseline fetal heart rate is 150/min, with uniform decelerations beginning at the peak of the contraction and a return to baseline after the contraction is over. Which of the following actions should the nurse take?

• A. Decrease the rate of infusion of the maintenance IV solution.
• B. Discontinue the infusion of the IV oxytocin.
• C. Increase the rate of infusion of the IV oxytocin.
• D. Slow the client's breathing rate.

Correct answer: B

Rationale: The described pattern suggests late decelerations, indicating uteroplacental insufficiency. Discontinuing the oxytocin infusion helps reduce uterine contractions, improving placental blood flow and fetal oxygenation. This intervention is essential to prevent fetal compromise and potential harm during labor. Choice A is incorrect because decreasing the rate of the maintenance IV solution does not directly address the cause of the late decelerations. Choice C is incorrect because increasing the rate of IV oxytocin can worsen uterine contractions, exacerbating the fetal distress. Choice D is incorrect because slowing the client's breathing rate is not indicated in the management of late decelerations during labor.

4. After an amniotomy, what is the priority nursing action?

• A. Observe color and consistency of fluid
• B. Assess the fetal heart rate pattern
• C. Assess the client's temperature
• D. Evaluate the client for the presence of chills and increased uterine tenderness using palpation

Correct answer: B

Rationale: After an amniotomy, the priority nursing action is to assess the fetal heart rate pattern. This is crucial to monitor for any signs of fetal distress, as changes in the fetal heart rate could indicate potential complications related to the procedure. Observing the color and consistency of the fluid (Choice A) is important but not the priority over assessing fetal well-being. Assessing the client's temperature (Choice C) and evaluating the client for chills and increased uterine tenderness (Choice D) are not immediate priorities following an amniotomy.

5. A healthcare provider is admitting a client who has severe preeclampsia at 35 weeks of gestation and is reviewing the provider's orders. Which of the following orders requires clarification?

• A. Assess deep tendon reflexes every hour.
• B. Obtain a daily weight.
• C. Continuous fetal monitoring
• D. Ambulate twice daily

Correct answer: D

Rationale: The correct answer is D. Ambulating twice daily is not recommended for a client with severe preeclampsia. Clients with severe preeclampsia are at risk for seizures and should be on bed rest to prevent complications. Ambulation can increase blood pressure and the risk of seizure activity in these clients. Assessing deep tendon reflexes, obtaining a daily weight, and continuous fetal monitoring are all appropriate and important interventions for a client with severe preeclampsia to monitor for signs of worsening condition and fetal well-being.

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