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. 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.

3. What is the purpose of amniocentesis?

• A. To induce abortion
• B. To detect genetic abnormalities in the fetus
• C. To determine the baby's gender
• D. To monitor fetal growth

Correct answer: B

Rationale: Amniocentesis is a diagnostic procedure used to detect genetic abnormalities in the fetus, such as chromosomal disorders like Down syndrome. It is not performed to induce abortion. The primary purpose of amniocentesis is to assess the genetic health of the fetus, not to determine the baby's gender (Choice C). While amniocentesis can provide information about the baby's health and development, it is not primarily used for monitoring fetal growth (Choice D). Therefore, the correct answer is B.

4. What is the typical sex chromosome pattern for males?

• A. XX
• B. XYY
• C. XY
• D. XXY

Correct answer: C

Rationale: The correct answer is C: XY. In males, the typical sex chromosome pattern consists of one X chromosome and one Y chromosome. Choice A (XX) is the sex chromosome pattern for females. Choice B (XYY) is a chromosomal disorder where males have an extra Y chromosome. Choice D (XXY) is the sex chromosome pattern associated with Klinefelter syndrome, a condition where males have an extra X chromosome.

5. A charge nurse is teaching a group of staff nurses about fetal monitoring during labor. Which of the following findings should the charge nurse instruct the staff members to report to the provider?

• A. Contraction durations of 95 to 100 seconds
• B. Contraction frequency of 2 to 3 minutes apart
• C. Absent early deceleration of fetal heart rate
• D. Fetal heart rate is 140/min

Correct answer: A

Rationale: The correct answer is A. Contraction durations of 95 to 100 seconds are prolonged, indicating uterine hyperstimulation, which can lead to fetal distress and requires immediate intervention. Reporting this finding to the provider is crucial to ensure timely management and prevent adverse outcomes. Choice B, contraction frequency of 2 to 3 minutes apart, is within the normal range and does not raise immediate concerns. Choice C, absent early deceleration of fetal heart rate, is a reassuring finding suggesting fetal well-being. Choice D, a fetal heart rate of 140/min, is also normal for a fetus and does not typically require immediate reporting unless it deviates significantly from the baseline or is accompanied by other concerning signs.

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