Nursing Elites

1. A client who has mild preeclampsia and will be caring for herself at home during the last 2 months of pregnancy is receiving teaching from a healthcare provider. Which statement by the client indicates an understanding of the teaching?

• A. “I will count baby’s kicks every other day.”
• B. “I will alternate the arm used to check my blood pressure.”
• C. “I will consume 50 grams of protein daily.”
• D. ---

Correct answer: B

Rationale: The correct answer is B. Alternating arms for blood pressure checks ensures more accurate readings and helps monitor preeclampsia. Option A, counting baby's kicks every other day, is not specific to managing preeclampsia. Option C, consuming 50 grams of protein daily, is important for a healthy diet during pregnancy but does not directly relate to preeclampsia management.

2. When reviewing the electronic medical record of a postpartum client, which of the following factors places the client at risk for infection?

• A. Meconium-stained amniotic fluid
• B. Placenta previa
• C. Midline episiotomy
• D. Gestational hypertension

Correct answer: C

Rationale: The correct answer is C: Midline episiotomy. An episiotomy is a surgical incision made during childbirth to enlarge the vaginal opening. This procedure increases the risk of infection in the postpartum period due to the incision site being a potential entry point for pathogens. Meconium-stained amniotic fluid (choice A) is a risk factor for fetal distress but does not directly increase the mother's risk of infection. Placenta previa (choice B) is a condition where the placenta partially or completely covers the cervix, leading to potential bleeding issues but not necessarily an increased risk of infection. Gestational hypertension (choice D) is a hypertensive disorder that affects some pregnant women but is not directly associated with an increased risk of infection in the postpartum period.

3. Which FHR finding is the most concerning to the nurse providing care to a laboring client?

• A. Accelerations with fetal movement.
• B. Early decelerations.
• C. Average FHR of 126 beats per minute.
• D. Late decelerations.

Correct answer: D

Rationale: Late decelerations are caused by uteroplacental insufficiency, resulting in fetal hypoxemia. They are considered ominous if persistent, indicating compromised oxygen supply to the fetus. Accelerations with fetal movement (Choice A) are reassuring signs of fetal well-being. Early decelerations (Choice B) are typically benign, associated with head compression during contractions. An average FHR of 126 beats per minute (Choice C) falls within the normal range for fetal heart rate and is not concerning. Therefore, the most concerning FHR finding in a laboring client is late decelerations (Choice D).

4. Which of the following is a sexually transmitted infection that, in advanced stages, can attack major organ systems?

• A. Rubella
• B. Syphilis
• C. Cystic fibrosis
• D. Phenylketonuria

Correct answer: B

Rationale: Syphilis is the correct answer. Syphilis is a sexually transmitted infection caused by the bacterium Treponema pallidum. If left untreated, it can progress through various stages and potentially attack major organ systems, causing severe complications. Rubella, Cystic fibrosis, and Phenylketonuria are not sexually transmitted infections. Rubella is a viral infection, Cystic fibrosis is a genetic disorder affecting the lungs and digestive system, and Phenylketonuria is a genetic metabolic disorder. These conditions do not typically affect major organ systems in the same way as untreated syphilis.

5. What additional assessment is required for the postoperative care of a pregnant woman who undergoes abdominal surgery for appendicitis?

• A. Intake and output (I&O) and intravenous (IV) site.
• B. Signs and symptoms of infection.
• C. Vital signs and incision.
• D. Fetal heart rate (FHR) and uterine activity.

Correct answer: D

Rationale: The correct additional assessment for postoperative care of a pregnant woman requiring abdominal surgery for appendicitis is monitoring the fetal heart rate (FHR) and uterine activity. This is crucial due to the presence of the fetus. Continuous fetal and uterine monitoring should be prioritized to ensure the well-being of both the mother and the baby. While assessing I&O levels and the IV site are common postoperative care procedures, they are not specific to the unique needs of a pregnant woman. Evaluating for signs and symptoms of infection is important for any postoperative patient but is not the additional assessment required specifically for a pregnant woman in this scenario. Routine vital signs and incision evaluation are standard components of postoperative care but do not address the specific needs related to the fetus and the uterus in this case.

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