Nursing Elites

1. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?

• A. 75 mg/dl before lunch. This is low; better eat now.
• B. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time.
• C. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin.
• D. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

Correct answer: D

Rationale: 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be less than 60 mg/dl. Snacks before sleeping can be helpful. The premeal acceptable range is 60 to 99 mg/dl. The readings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating, the readings should be less than 120 mg/dl.

2. A client is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take?

• A. Place a snug dressing on the client’s nipple when not breastfeeding
• B. Ensure the newborn’s mouth is wide open before latching to the breast
• C. Encourage the client to limit the newborn’s feeding to 10 minutes on each breast
• D. Instruct the client to begin the feeding with the nipple that is most tender

Correct answer: B

Rationale: Ensuring the newborn's mouth is wide open before latching is crucial for achieving a proper latch, which can help reduce nipple soreness. Placing a snug dressing on the nipple when not breastfeeding (choice A) can lead to further irritation and hinder healing. Encouraging the client to limit the newborn’s feeding to 10 minutes on each breast (choice C) may not be adequate for effective feeding as infants should feed until they are satisfied. Instructing the client to begin feeding with the most tender nipple (choice D) can worsen the soreness as it may not allow the baby to feed effectively.

3. A client is 4 hours postpartum and is experiencing hypovolemic shock. Which of the following actions should the nurse take?

• A. Administer indomethacin
• B. Insert a second 22-gauge IV catheter.
• C. Insert an indwelling urinary catheter.
• D. Administer oxygen at 4L/min via nasal cannula.

Correct answer: D

Rationale: In hypovolemic shock, there is decreased oxygen delivery to tissues. Administering oxygen at 4L/min via nasal cannula can help improve oxygenation and support tissue perfusion. Indomethacin (Choice A) is a nonsteroidal anti-inflammatory drug and is not indicated in the management of hypovolemic shock. Inserting a second 22-gauge IV catheter (Choice B) may be necessary for fluid resuscitation, but oxygen administration takes precedence. Inserting an indwelling urinary catheter (Choice C) may be considered for monitoring urinary output, but it is not the priority action in managing hypovolemic shock.

4. A client is in the second stage of labor. Which of the following manifestations should the nurse expect?

• A. The client expels the placenta
• B. The client experiences gradual dilation of the cervix
• C. The client begins having regular contractions
• D. The client delivers the newborn

Correct answer: D

Rationale: During the second stage of labor, the cervix is fully dilated, and the client delivers the newborn. The expulsion of the placenta occurs during the third stage of labor, not the second stage. Regular contractions typically begin in the first stage of labor, not the second. Gradual dilation of the cervix occurs during the first stage of labor, specifically during the active phase.

5. Chromosomes are _____ structures found in cells.

• A. rod-shaped
• B. circular
• C. cone-shaped
• D. octagonal

Correct answer: A

Rationale: Chromosomes are rod-shaped structures that carry genetic information in the form of DNA. They are typically seen as elongated structures when visualized under a microscope. Choice B, circular, is incorrect as chromosomes do not have a circular shape; they are linear. Choice C, cone-shaped, is not accurate as chromosomes do not resemble cones in any way. Choice D, octagonal, is also incorrect as chromosomes do not have an octagonal appearance. Therefore, the correct answer is A, rod-shaped, which accurately describes the shape of chromosomes.

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