Nursing Elites

1. 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.

2. A new parent is receiving discharge teaching about car seat safety from a nurse. Which statement by the parent indicates an understanding of the teaching?

• A. “I should position my baby’s car seat at a 45-degree angle in the car.”
• B. “I should place the car seat rear-facing until my baby is 12 months old.”
• C. “I should place the harness snugly in a slot above my baby’s shoulders.”
• D. “I should position the retainer clip at the top of my baby’s abdomen.”

Correct answer: A

Rationale: The correct answer is A. Positioning the car seat at a 45-degree angle is crucial to prevent the baby's head from falling forward, which can obstruct the airway. Choice B is incorrect because the recommendation is to keep the car seat rear-facing until the baby reaches the height or weight limit set by the car seat manufacturer, typically beyond 12 months. Choice C is incorrect as the harness should be snugly placed at or below the baby's shoulders, not above. Choice D is incorrect as the retainer clip should be positioned at armpit level to secure the harness straps properly.

3. Which of the following statements is a symptom of cystic fibrosis in children?

• A. Cystic fibrosis leads to uncontrollable muscle movements and personality changes.
• B. Cystic fibrosis leads to the excessive production of thick mucus that clogs the pancreas and lungs.
• C. Cystic fibrosis causes red blood cells to clump together, obstructing small blood vessels and decreasing the oxygen supply.
• D. Cystic fibrosis causes the central nervous system to degenerate, resulting in death.

Correct answer: B

Rationale: The correct answer is B. Cystic fibrosis is a genetic disorder that causes the body to produce thick, sticky mucus. This mucus can clog the airways in the lungs and obstruct the pancreas, leading to severe respiratory and digestive problems. Choice A is incorrect because uncontrollable muscle movements and personality changes are not typical symptoms of cystic fibrosis. Choice C is incorrect because cystic fibrosis does not directly cause red blood cells to clump together and obstruct small blood vessels. Choice D is incorrect because cystic fibrosis primarily affects the respiratory and digestive systems, not the central nervous system.

4. At 12 hours after the birth of a healthy infant, the mother complains of feeling constant vaginal pressure. The nurse determines the fundus is firm and at midline with moderate rubra lochia. Which action should the nurse take?

• A. Check the suprapubic area for distention
• B. Inform the client to take a warm sitz bath
• C. Inspect the client's perineal and rectal areas
• D. Apply a fresh pad and check in 1 hour

Correct answer: C

Rationale: In this situation, the mother's complaint of constant vaginal pressure along with a firm fundus and moderate rubra lochia indicates a potential perineal injury or hematoma. The correct action for the nurse to take is to inspect the client's perineal and rectal areas to assess for any signs of trauma or hematoma. Checking the suprapubic area for distention (Choice A) is not the priority here since the symptoms suggest a perineal issue. Advising a warm sitz bath (Choice B) may not address the underlying issue and could potentially worsen any existing trauma. Applying a fresh pad and checking in 1 hour (Choice D) does not address the need for immediate assessment of the perineal and rectal areas in response to the reported symptoms.

5. _____ is a type of estrogen, prescribed in the 1940s and 1950s to pregnant women, that is said to have caused testicular, vaginal, and cervical cancer in some offspring.

• A. Androsterone
• B. Adiponectin
• C. Progestin
• D. Diethylstilbestrol

Correct answer: D

Rationale: Diethylstilbestrol (DES) is a synthetic estrogen that was prescribed to pregnant women in the 1940s and 1950s to prevent miscarriages. However, it was later discovered that DES exposure in utero could lead to health issues in offspring, including an increased risk of testicular, vaginal, and cervical cancer. Choice A, Androsterone, is a steroid hormone produced in small amounts in humans and unlikely to be associated with the adverse effects described. Choice B, Adiponectin, is a protein hormone that plays a role in regulating glucose levels and fatty acid breakdown, not related to the adverse effects mentioned. Choice C, Progestin, is a synthetic form of progesterone used in birth control and hormone therapy, not linked to the specific health concerns associated with DES exposure.

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