Nursing Elites

1. A nurse on an antepartum unit is reviewing the medical records for four clients. Which of the following clients should the nurse assess first?

• A. A client who has diabetes mellitus and an HbA1c of 5.8%
• B. A client who has preeclampsia and a creatinine level of 1.1 mg/dL
• C. A client who has hyperemesis gravidarum and a sodium level of 110 mEq/L
• D. A client who has placenta previa and a hematocrit of 36%

Correct answer: C

Rationale: A sodium level of 110 mEq/L is critically low and can indicate severe dehydration and electrolyte imbalance, requiring immediate intervention.

2. The client who is 40 weeks gestation seems upset and tells the nurse that the physician told her she needs to have a nonstress test. The client asks why she needs the test. The nurse’s best response would be:

• A. This is a test to see if your stress level is affecting your baby’s growth and well-being.
• B. This is a test to see if your baby will be able to withstand the stress of labor.
• C. This is a test to assess your baby’s well-being now that you are due to deliver soon.
• D. This is a test to let us know if your baby needs to be delivered to avoid a bad outcome.

Correct answer: C

Rationale: The correct response is C because the nonstress test is specifically used to assess the baby's well-being close to the due date. It helps determine if the baby is receiving enough oxygen and nutrients in the womb. Choice A is incorrect as the test does not assess the mother's stress level but focuses on fetal well-being. Choice B is incorrect as the test does not predict the baby's ability to withstand labor. Choice D is incorrect because the test does not solely indicate if the baby needs to be delivered to avoid a bad outcome; rather, it assesses the current well-being of the baby.

3. Daisy was always unusually short for her age. She was unable to conceive a child after marriage, and upon visiting a doctor, she was prescribed estrogen replacement therapy. Daisy is most likely suffering from:

• A. Phenylketonuria (PKU).
• B. Cystic fibrosis.
• C. Turner syndrome.
• D. Huntington’s disease (HD).

Correct answer: C

Rationale: Daisy's symptoms of short stature and infertility, along with the prescription of estrogen replacement therapy, are indicative of Turner syndrome. Turner syndrome is a genetic condition in which a female is partially or completely missing one X chromosome. This results in short stature, infertility, and other physical characteristics. Phenylketonuria (PKU) is a metabolic disorder caused by a mutation in the gene responsible for the breakdown of the amino acid phenylalanine. Cystic fibrosis is a genetic disorder affecting the respiratory and digestive systems. Huntington's disease (HD) is a neurodegenerative disorder that affects muscle coordination and leads to cognitive decline.

4. What determines a child’s sex?

• A. Presence of teratogens at the time of conception.
• B. Sex chromosome received from the mother.
• C. Presence of teratogens at the time of ovulation.
• D. Sex chromosome received from the father.

Correct answer: D

Rationale: The correct answer is the sex chromosome received from the father. The father contributes either an X or Y chromosome, which determines the child's sex. This occurs at the moment of fertilization when the sperm carrying either an X (resulting in a female) or Y (resulting in a male) chromosome fertilizes the egg. Choices A, B, and C are incorrect because the presence of teratogens at the time of conception or ovulation does not determine the child's sex. While the sex chromosome received from the mother is important, it is the father's contribution that ultimately determines the child's sex.

5. A client who is 24 weeks gestation arrives at the clinic reporting swollen hands. On examination, the nurse notes the client has had a rapid weight gain over six weeks. Which action should the nurse implement next?

• A. Review the client's previous blood pressures in the chart.
• B. Obtain the client's blood pressure.
• C. Observe and time the client's contractions.
• D. Examine the client for pedal edema.

Correct answer: B

Rationale: Swollen hands and rapid weight gain could be signs of preeclampsia, so the next step is to check the client's blood pressure. Elevated blood pressure is a key indicator in assessing for preeclampsia in pregnancy. Reviewing the client's previous blood pressures may provide additional context but obtaining the current blood pressure is crucial for immediate assessment. Observing and timing contractions are not relevant in this scenario as the client is not presenting with signs of active labor. Examining for pedal edema is important in assessing for fluid retention, but obtaining the blood pressure takes precedence in this case due to the potential seriousness of preeclampsia.

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