Nursing Elites

1. The nurse places one hand above the symphysis while massaging the fundus of a multiparous client whose uterine tone is boggy 15 minutes after delivering a 7-pound, 10-ounce (3220-gram) infant. Which information should the nurse provide to the client about these findings?

• A. The uterus should be firm to prevent an intrauterine infection.
• B. Both the lower uterine segment and the fundus must be massaged.
• C. A firm uterus prevents the endometrial lining from being sloughed.
• D. Clots may form inside a boggy uterus and need to be expelled.

Correct answer: D

Rationale: After childbirth, a boggy uterus indicates poor uterine tone, which can lead to the formation of clots. Massaging the fundus helps the uterus contract and expel clots, reducing the risk of postpartum hemorrhage. Choices A, B, and C are incorrect because the main concern with a boggy uterus is the risk of clot formation and postpartum hemorrhage, not solely preventing intrauterine infection, massaging the lower uterine segment, or preventing the endometrial lining from sloughing.

2. 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.

3. A client who is pregnant and follows a vegan diet asks a nurse for guidance on foods high in calcium. Which of the following foods has the highest amount of calcium?

• A. ½ cup cubed avocado
• B. 1 large banana
• C. 1 medium potato
• D. 1 cup cooked broccoli

Correct answer: D

Rationale: The correct answer is D: 1 cup of cooked broccoli. Broccoli is an excellent source of calcium, making it a suitable choice for a vegan diet. Avocado (Choice A), banana (Choice B), and potato (Choice C) are not significant sources of calcium compared to broccoli. Avocado and banana are primarily sources of other nutrients like healthy fats and potassium, respectively. Potato is a good source of vitamin C and potassium but not calcium. Therefore, for a pregnant client following a vegan diet and seeking calcium-rich foods, cooked broccoli is the most appropriate choice.

4. Which of the following illnesses causes degeneration of the central nervous system?

• A. Tay-Sachs disease
• B. Cystic fibrosis
• C. Turner syndrome
• D. Klinefelter syndrome

Correct answer: A

Rationale: Tay-Sachs disease is a genetic disorder that causes a progressive degeneration of the central nervous system, particularly in infants. Choice B, Cystic fibrosis, is a genetic disorder that primarily affects the lungs and digestive system, not the central nervous system. Choices C and D, Turner syndrome and Klinefelter syndrome, are chromosomal disorders that do not directly involve degeneration of the central nervous system.

5. 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.

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