Nursing Elites

1. In the prenatal record, the nurse should record for the pregnant client who has a 3-year-old child at home, a term birth, a miscarriage at 10 weeks’ gestation, and a set of twins who died within 24 hours:

• A. Gravida 2, para 1.
• B. Gravida 3, para 3.
• C. Gravida 4, para 2.
• D. Gravida 5, para 4.

Correct answer: C

Rationale: The correct answer is C: 'Gravida 4, para 2.' Gravida refers to the total number of pregnancies, including the current one. In this case, the client has been pregnant a total of 4 times, so gravida is 4. Para is the number of pregnancies that have reached viability, which is 2 in this case. The client has had a term birth and a set of twins who died within 24 hours, totaling 2 pregnancies that reached viability. Choices A, B, and D are incorrect because they do not accurately reflect the client's obstetric history based on the information provided.

2. A primigravida at 36 weeks gestation who is RH-negative experienced abdominal trauma in a motor vehicle collision. Which assessment finding is most important for the nurse to report to the healthcare provider?

• A. Fetal heart rate at 162 beats per minute
• B. Mild contractions every 10 minutes
• C. Trace of protein in the urine
• D. Positive fetal hemoglobin testing

Correct answer: D

Rationale: The correct answer is 'Positive fetal hemoglobin testing' (D). Positive fetal hemoglobin testing (Kleihauer-Betke test) indicates fetal-maternal hemorrhage, which is critical in an RH-negative mother due to the risk of isoimmunization. This condition can lead to sensitization of the mother's immune system against fetal blood cells, potentially causing hemolytic disease of the newborn in subsequent pregnancies. Reporting this finding promptly is crucial for appropriate management and interventions. Choices A, B, and C are not as critical in this scenario. While monitoring fetal heart rate and contractions is important, the detection of fetal-maternal hemorrhage takes precedence due to the serious implications it poses for the current and future pregnancies of an RH-negative mother.

3. A newborn is 1 hour old with a respiratory rate of 50/min, a heart rate of 130/min, and an axillary temperature of 36.1°C (97°F). Which of the following actions should be taken?

• A. Give the newborn a warm bath.
• B. Apply a cap to the newborn's head.
• C. Reposition the newborn.
• D. Obtain an oxygen saturation level.

Correct answer: B

Rationale: Applying a cap to the newborn's head is the correct action in this scenario. Newborns are at risk of heat loss due to their high surface area to volume ratio, and maintaining their body temperature is crucial to prevent hypothermia. Giving a warm bath can further increase heat loss and is not recommended. Repositioning the newborn may not address the primary concern of temperature regulation. While monitoring oxygen saturation is important, addressing thermal regulation takes precedence in this situation.

4. As women reach the end of their childbearing years, does ovulation become more regular?

• A. TRUE
• B. FALSE
• C. Rarely
• D. Always

Correct answer: B

Rationale: The correct answer is B: FALSE. As women age and reach the end of their childbearing years, ovulation becomes less regular due to hormonal changes associated with menopause. This can result in irregular ovulation patterns or even the cessation of ovulation entirely. Choice A is incorrect because ovulation does not become more regular with age. Choices C and D are also incorrect as they do not accurately reflect the changes in ovulation patterns that occur as women approach the end of their childbearing years.

5. Which of the following is most likely to develop sickle cell anemia?

• A. European American
• B. Native American
• C. African American
• D. Asian American

Correct answer: C

Rationale: Sickle cell anemia is most commonly found in individuals of African American descent. This is because sickle cell trait provides some protection against malaria, and historically, regions where malaria is or was prevalent have higher rates of sickle cell anemia. Therefore, individuals with African ancestry are at a higher risk of developing sickle cell anemia compared to other populations. Choices A, B, and D are less likely to develop sickle cell anemia due to lower genetic prevalence in their respective populations.

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