Nursing Elites

1. Preconception counseling is crucial for the safe management of diabetic pregnancies. Which complication is commonly associated with poor glycemic control before and during early pregnancy?

• A. Frequent episodes of maternal hypoglycemia
• B. Congenital anomalies in the fetus
• C. Hydramnios
• D. Hyperemesis gravidarum

Correct answer: B

Rationale: Preconception counseling is essential as strict metabolic control before conception and in the early weeks of gestation helps reduce the risk of congenital anomalies. Frequent episodes of maternal hypoglycemia usually occur during the first trimester due to hormonal changes, affecting insulin production and use, rather than before conception. Hydramnios is more common in diabetic pregnancies, typically seen in the third trimester, not during early pregnancy. Hyperemesis gravidarum, although it may lead to hypoglycemic events, is related to decreased food intake and glucose transfer to the fetus, exacerbating hypoglycemia rather than being directly associated with poor glycemic control before and during early pregnancy.

2. The nurse is planning discharge teaching for four mothers. Which postpartum client is at highest risk for psychological difficulties during the postpartum period?

• A. A primiparous woman who has recently migrated to the US with her spouse
• B. A multiparous client who lives with her husband and his family members
• C. A multiparous female with a large family living in a community
• D. A primiparous adolescent living at home with her parents and significant other

Correct answer: A

Rationale: A primiparous woman who has recently migrated to the US with her spouse is at the highest risk for psychological difficulties during the postpartum period. Recent migration and adjustment to a new environment can increase the risk of postpartum depression, especially when combined with the challenges of being a new mother. Choice B, a multiparous client living with her husband and his family, may have social support from family members, which can be protective against psychological difficulties. Choice C, a multiparous female with a large family living in a community, also indicates potential social support. Choice D, a primiparous adolescent living at home with her parents and significant other, may have a support system in place with her family and significant other.

3. 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.

4. When assessing a woman in the first stage of labor, which clinical finding will alert the nurse that uterine contractions are effective?

• A. Dilation of the cervix.
• B. Descent of the fetus to –2 station.
• C. Rupture of the amniotic membranes.
• D. Increase in bloody show.

Correct answer: A

Rationale: During the first stage of labor, effective uterine contractions lead to cervical dilation. Dilation of the cervix is a key indicator that uterine contractions are progressing labor. Descent of the fetus to -2 station (Choice B) is related to the fetal position in the pelvis and not a direct indicator of uterine contraction effectiveness. Rupture of the amniotic membranes (Choice C) signifies the rupture of the fluid-filled sac surrounding the fetus and does not directly reflect uterine contraction effectiveness. An increase in bloody show (Choice D) can be a sign of impending labor, but it is not a direct indicator of uterine contraction effectiveness.

5. During a prenatal visit, for which of the following clients should the nurse auscultate the fetal heart rate?

• A. A client who has an ultrasound confirming a molar pregnancy
• B. A client who has a crown-rump length corresponding to 7 weeks gestation
• C. A client who has a positive urine pregnancy test 1 week after missed menses
• D. A client who has felt quickening for the first time

Correct answer: D

Rationale: The correct answer is D because feeling quickening typically occurs around 18-20 weeks of gestation, indicating fetal movement. This is an appropriate time to auscultate the fetal heart rate. Choice A is incorrect because a molar pregnancy is not a viable pregnancy, and auscultating the fetal heart rate in this case is not applicable. Choice B is incorrect because a crown-rump length of 7 weeks gestation is too early for fetal heart rate auscultation. Choice C is incorrect because a positive urine pregnancy test alone does not indicate the appropriate timing for fetal heart rate auscultation.

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