Nursing Elites

1. A client is receiving oxytocin by continuous IV infusion for labor induction. Which of the following interventions should the nurse include in the plan?

• A. Increase the infusion rate every 30 to 60 minutes.
• B. Maintain the client in a supine position.
• C. Titrate the infusion rate by 4 milliunits/min.
• D. Limit IV intake to 4 L per 24 hours.

Correct answer: A

Rationale: The correct answer is to increase the infusion rate every 30 to 60 minutes. This approach allows for the careful monitoring and adjustment of oxytocin administration during labor induction. Choice B is incorrect because maintaining the client in a supine position can decrease blood flow to the placenta and compromise fetal oxygenation. Choice C is incorrect as titrating the infusion rate by 4 milliunits/min is not a standard practice for oxytocin administration. Choice D is incorrect as limiting IV intake to 4 L per 24 hours is not specifically related to the administration of oxytocin for labor induction.

2. A client is experiencing preterm labor and has a prescription for 4 doses of dexamethasone 6 mg IM every 12 hours. The available concentration is dexamethasone 10 mg/mL. How many mL of dexamethasone should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use trailing zero.)

• A. 0.6 mL
• B. ---
• C. ---
• D. ---

Correct answer: A

Rationale: Calculation: (6 mg/dose) / (10 mg/mL) = 0.6 mL per dose. The correct answer is 0.6 mL. This calculation is obtained by dividing the dose needed (6 mg) by the concentration available (10 mg/mL). The resulting value is 0.6 mL per dose. Choices B, C, and D are not applicable as the correct answer has been calculated accurately.

3. Which of the following statements is true of menstruation?

• A. During this time, the endometrium is shed.
• B. During this time, an unfertilized egg is discharged.
• C. During this time, a female can engage in sexual activity with her partner.
• D. During this time, a fertilized egg implants in the uterine lining.

Correct answer: B

Rationale: The correct statement regarding menstruation is that during this time, an unfertilized egg is discharged along with the shedding of the uterine lining. Choice A is incorrect because the endometrium is shed during menstruation. Choice C is incorrect as menstruation does not prevent a female from engaging in sexual activity with her partner. Choice D is incorrect as a fertilized egg does not undergo mitosis during menstruation but rather implants in the uterine lining for further development.

4. A client in labor requests nonpharmacological pain management. Which of the following nursing actions promotes client comfort?

• A. Assisting the client into a squatting position
• B. Having the client lie in a supine position
• C. Applying fundal pressure during contractions
• D. Encouraging the client to void every 6 hours

Correct answer: A

Rationale: Assisting the client into a squatting position promotes comfort during labor. This position can help relieve pain by utilizing gravity, allowing the pelvic outlet to widen, and potentially facilitating the progress of labor. Lying in a supine position (Choice B) can hinder labor progression and increase discomfort. Applying fundal pressure (Choice C) can be inappropriate and may cause harm as it is not routinely recommended during labor. Encouraging the client to void every 6 hours (Choice D) is important for bladder management but does not directly address pain relief during labor.

5. Jill bears the genetic code for Von Willebrand disease, but she has never developed the illness herself. Jill would be considered:

• A. a carrier of the recessive gene that causes the disease.
• B. susceptible to the disease after adolescence.
• C. an acceptor of the recessive gene that causes the disease.
• D. susceptible to the disease in late adulthood.

Correct answer: A

Rationale: Jill is a carrier of the recessive gene for Von Willebrand disease. Being a carrier means that she has one copy of the gene but does not show symptoms of the disease. Carriers can pass on the gene to their offspring. Choice B is incorrect as being a carrier does not mean she is susceptible to developing the disease after adolescence. Choice C is incorrect as 'acceptor' is not a term used in genetics in this context. Choice D is incorrect as susceptibility to the disease is not related to late adulthood in carriers of a recessive gene.

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