Nursing Elites

1. A client at 38 weeks of gestation has a prescription for intravaginal misoprostol. Which of the following statements should the nurse make?

• A. “You will need to stay in a side-lying position for 30 minutes after each dose.”
• B. “You will receive an IV infusion of oxytocin 1 hour after your last dose.”
• C. “You will receive a magnesium supplement immediately following therapy.”
• D. “You will need to have a full bladder before the therapy begins.”

Correct answer: A

Rationale: The correct answer is A. Instructing the client to stay in a side-lying position after receiving misoprostol intravaginally is essential. This position helps keep the medication in place, allowing for better absorption. Choice B is incorrect because oxytocin administration is not typically indicated after misoprostol use. Choice C is incorrect as magnesium supplementation is not part of the standard protocol for misoprostol administration. Choice D is incorrect as having a full bladder is not necessary before initiating misoprostol therapy.

2. A client at 30 weeks gestation reports that she has not felt the baby move in the last 24 hours. Concerned, she arrives in a panic at the obstetric clinic where she is immediately sent to the hospital. Which assessment warrants immediate intervention by the nurse?

• A. Fetal Heart rate 60 beats per minute
• B. Ruptured amniotic membrane
• C. Onset of uterine contractions
• D. Leaking amniotic fluid

Correct answer: A

Rationale: A fetal heart rate of 60 beats per minute is significantly below the normal range (110-160 bpm) and indicates fetal distress, requiring immediate intervention. This low heart rate can be a sign of fetal compromise or distress, necessitating urgent evaluation and intervention to ensure the well-being of the fetus. Choices B, C, and D do not indicate immediate fetal distress requiring urgent intervention. Ruptured amniotic membrane, onset of uterine contractions, and leaking amniotic fluid are important assessments but do not present an immediate threat to the fetus's life like a severely low fetal heart rate.

3. Rubella, also called German measles, is a viral infection passed from the mother to the fetus that can cause birth defects such as deafness, intellectual disabilities, blindness, and heart disease in the embryo.

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

Correct answer: A

Rationale: Rubella, also known as German measles, is a viral infection that can lead to severe birth defects when contracted by a mother during pregnancy. Rubella is the correct answer because it is specifically associated with causing birth defects such as deafness, intellectual disabilities, blindness, and heart disease in the embryo. Syphilis (Choice B) can be passed from mother to fetus but does not cause the mentioned birth defects associated with Rubella. Cystic fibrosis (Choice C) and Phenylketonuria (Choice D) are genetic conditions and not infections transmitted from mother to fetus, making them incorrect choices in this context.

4. A nurse on a labor and delivery unit is providing teaching to a client who plans to use hypnosis to control labor pain. Which of the following information should the nurse include?

• A. Focusing on controlling body functions
• B. Synchronized breathing is often helpful during hypnosis
• C. Hypnosis can be beneficial if practiced during the prenatal period
• D. Hypnosis is ineffective for controlling pain associated with labor

Correct answer: C

Rationale: Hypnosis can be an effective method of pain control during labor, especially if practiced during the prenatal period. Choice A is not specific to hypnosis and may not be directly related. Choice B is not essential for hypnosis and may not always be required. Choice D is incorrect as hypnosis has been shown to be beneficial for managing labor pain when done correctly, making it an inappropriate option to include in the teaching.

5. A healthcare provider is assessing a newborn upon admission to the nursery. Which of the following should the provider expect?

• A. Bulging Fontanels
• B. Nasal Flaring
• C. Length from head to heel of 40 cm (15.7 in)
• D. Chest circumference 2 cm (0.8 in) smaller than the head circumference

Correct answer: D

Rationale: Upon admission to the nursery, a healthcare provider should expect the newborn's chest circumference to be slightly smaller than the head circumference. This is a normal finding in newborns due to their physiological development. Bulging fontanels (Choice A) can indicate increased intracranial pressure, which is abnormal. Nasal flaring (Choice B) is a sign of respiratory distress and is also an abnormal finding. While a length from head to heel of 40 cm (15.7 in) (Choice C) falls within the normal range for newborns, it is not a specific expectation upon admission to the nursery. Therefore, the correct expectation for a newborn upon admission is for the chest circumference to be slightly smaller than the head circumference.

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