Nursing Elites

1. An adolescent is being taught about levonorgestrel contraception by a school nurse. What information should the nurse include in the teaching?

• A. You should take the medication within 72 hours following unprotected sexual intercourse.
• B. Do not take this medication if you are on an oral contraceptive.
• C. If you do not start your period within 5 days of taking this medication, you will need a pregnancy test.
• D. One dose of this medication will prevent pregnancy for 14 days after taking it.

Correct answer: A

Rationale: Levonorgestrel is an emergency contraceptive that works by inhibiting ovulation to prevent conception. It is most effective when taken as soon as possible within 72 hours following unprotected sexual intercourse. Therefore, the nurse should instruct the adolescent to take the medication promptly to maximize its effectiveness. Choice B is incorrect because levonorgestrel can be used even if the individual is on oral contraceptives. Choice C is incorrect as the efficacy of levonorgestrel is not determined by the onset of menstruation. Choice D is incorrect because levonorgestrel is a single-dose emergency contraceptive and does not provide protection for 14 days after ingestion.

2. When reinforcing teaching with new parents on bathing a newborn, a nurse observes a bluish-brown marking across the newborn's lower back. Which of the following statements should the nurse make concerning the variation?

• A. This is more commonly seen in newborns who have dark skin.
• B. This is a finding indicating hyperbilirubinemia.
• C. This is a forceps mark from an operative delivery.
• D. This is related to prolonged birth or trauma during delivery.

Correct answer: A

Rationale: A bluish-brown marking across the lower back is more commonly seen in newborns with dark skin. These markings are known as Mongolian spots and are benign. They are not related to hyperbilirubinemia, forceps marks, or trauma during delivery. Choice B is incorrect because hyperbilirubinemia presents as jaundice, not as a bluish-brown marking. Choice C is incorrect because forceps marks would have a different appearance and location. Choice D is incorrect as Mongolian spots are not related to prolonged birth or trauma during delivery.

3. When should a provider order a maternal serum alpha-fetoprotein (MSAFP) screening for pregnant clients?

• A. A client who has mitral valve prolapse
• B. A client who has been exposed to AIDS
• C. All pregnant clients
• D. A client who has a history of preterm labor

Correct answer: C

Rationale: Maternal serum alpha-fetoprotein (MSAFP) screening is recommended for all pregnant clients to assess the risk of neural tube defects. It is a routine screening test used to detect increased levels of alpha-fetoprotein in maternal blood, which may indicate a higher risk for conditions such as neural tube defects in the developing fetus. Therefore, all pregnant clients, regardless of their medical history or risk factors, should undergo MSAFP screening as part of routine prenatal care. Choices A, B, and D are incorrect because the MSAFP screening is not specific to certain medical conditions or histories; it is a standard screening procedure for all pregnant individuals to evaluate neural tube defect risk in the fetus.

4. A nurse is admitting a term newborn following a cesarean birth. The nurse observes that the newborn's skin is slightly yellow. This finding indicates the newborn is experiencing a complication related to which of the following?

• A. Maternal/newborn blood group incompatibility
• B. Absence of vitamin K
• C. Physiologic jaundice
• D. Maternal cocaine abuse

Correct answer: A

Rationale: The yellow skin observed in the newborn suggests jaundice. Maternal/newborn blood group incompatibility is a common cause of jaundice in newborns. This occurs when the mother and baby have different blood types, leading to the baby's immune system attacking the red blood cells, causing jaundice. Physiologic jaundice, which is a normal process due to the breakdown of red blood cells in newborns, typically presents after the first 24 hours of life. Absence of vitamin K leads to bleeding issues, not jaundice. Maternal cocaine abuse does not directly cause jaundice in newborns.

5. A healthcare provider is discussing the differences between true labor and false labor with a group of expectant parents. Which of the following characteristics should the healthcare provider include when discussing true labor?

• A. Contractions become stronger with walking.
• B. Discomfort can be relieved with a back massage.
• C. Contractions become irregular with a change in activity.
• D. Discomfort is felt above the umbilicus.

Correct answer: A

Rationale: During true labor, contractions typically become stronger and more regular with activity, such as walking. This is a key characteristic that helps differentiate true labor from false labor. In false labor, contractions often remain irregular and do not intensify with changes in activity. Choice B is incorrect because discomfort in true labor is not typically relieved with a back massage. Choice C is incorrect as contractions in true labor become stronger and more regular with activity rather than irregular. Choice D is incorrect because discomfort in true labor is usually felt in the lower abdomen and pelvis, not above the umbilicus.

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