Nursing Elites

1. A healthcare provider is reviewing the health record of a client who is pregnant. The provider indicated the client exhibits probable signs of pregnancy. Which of the following findings should the provider expect? (Select all that apply)

• A. Chadwick's sign
• B. Goodell's sign
• C. Ballottement
• D. All of the above

Correct answer: D

Rationale: Chadwick's sign, Goodell's sign, and ballottement are probable signs of pregnancy. Chadwick's sign refers to a bluish discoloration of the cervix and vaginal mucosa. Goodell's sign is the softening of the cervix due to increased vascularity. Ballottement is the rebound of the fetus when the cervix is tapped during a vaginal examination. Recognizing these signs is essential for healthcare providers in assessing pregnancy. Therefore, all of the above choices are correct as they are all probable signs of pregnancy. Choice D is the correct answer as it includes all the expected findings.

2. A healthcare provider is assisting with the care of a newborn immediately following birth. Which of the following nursing interventions is the highest priority?

• A. Initiating breastfeeding
• B. Performing the initial bath
• C. Giving a vitamin K injection
• D. Covering the newborn's head with a cap

Correct answer: D

Rationale: Covering the newborn's head with a cap is the highest priority immediately following birth to prevent heat loss. Newborns are at risk of hypothermia due to their immature thermoregulation, making it crucial to maintain their body temperature. By covering the newborn's head with a cap, heat loss through the head is minimized, helping to keep the baby warm and stable in the immediate post-birth period. Initiating breastfeeding, performing the initial bath, and giving a vitamin K injection are important interventions but are not as high a priority as ensuring the newborn's thermal stability.

3. A client who is at 40 weeks gestation and in active labor has 6 cm of cervical dilation and 100% cervical effacement. The client's blood pressure reading is 82/52 mm Hg. Which of the following nursing interventions should the nurse perform?

• A. Prepare for a cesarean birth.
• B. Assist the client to an upright position.
• C. Prepare for an immediate vaginal delivery.
• D. Assist the client to turn onto her side.

Correct answer: D

Rationale: Turning the client onto her side is the appropriate nursing intervention in this scenario. This position can help improve blood pressure by enhancing venous return, which may aid in increasing perfusion to vital organs. It can also alleviate pressure on the inferior vena cava, promoting better circulation and supporting blood pressure stabilization during labor. Choices A, B, and C are incorrect. A cesarean birth is not indicated based on the information provided. Assisting the client to an upright position may worsen her blood pressure due to decreased venous return. Lastly, there is no indication for an immediate vaginal delivery solely based on the client's blood pressure reading.

4. A nurse is caring for a client who is at 40 weeks of gestation and is in early labor. The client has a platelet count of 75,000/mm3 and is requesting pain relief. Which of the following treatment modalities should the nurse anticipate?

• A. Epidural analgesia
• B. Naloxone hydrochloride
• C. Attention-focusing
• D. Pudendal nerve block

Correct answer: C

Rationale: Attention-focusing and distraction techniques are types of nonpharmacological care that are effective in relieving labor pain.

5. A healthcare professional is preparing to collect a blood specimen from a newborn via a heel stick. Which of the following techniques should the professional use to help minimize the pain of the procedure for the newborn?

• A. Apply a cool pack to the heel for 10 minutes prior to the puncture.
• B. Request a prescription for IM analgesic.
• C. Use a manual lancet to pierce the skin.
• D. Place the newborn skin-to-skin on the mother's chest.

Correct answer: D

Rationale: Placing the newborn skin-to-skin on the mother's chest is an effective technique to significantly decrease the newborn's pain level and anxiety during a heel stick procedure. This approach provides comfort, warmth, and familiarity to the newborn, promoting a sense of security and reducing distress. It is important for the healthcare professional to implement this technique before, during, and after the procedure to optimize pain management and support newborn well-being. The other options, such as applying a cool pack, requesting an IM analgesic prescription, and using a manual lancet, are not appropriate for minimizing pain in a newborn during a heel stick procedure. Applying a cool pack may cause vasoconstriction and increase pain, requesting an IM analgesic for a routine heel stick is excessive, and using a manual lancet without additional comforting measures may not adequately address the newborn's pain and anxiety.

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