Nursing Elites

1. What advice is most important for a client in the first trimester of pregnancy experiencing nausea?

• A. Practice relaxation techniques when nausea begins.
• B. Increase fluid intake to 3 quarts daily.
• C. Avoid alcohol, caffeine, and smoking.
• D. Eliminate snacks between meals.

Correct answer: C

Rationale: During the first trimester of pregnancy, it is crucial to advise pregnant clients to avoid alcohol, caffeine, and smoking. These substances can worsen nausea and harm fetal development. By eliminating these substances, the client can help alleviate nausea and create a healthier environment for the developing fetus. Choices A, B, and D are not as critical in managing nausea during the first trimester. While relaxation techniques may help, avoiding harmful substances like alcohol, caffeine, and smoking takes precedence. Increasing fluid intake can be beneficial but not as crucial as avoiding harmful substances. Eliminating snacks between meals may not be necessary for all clients and is not directly related to managing nausea in the first trimester.

2. The client at 10 weeks' gestation is palpated with the fundus at 3 fingerbreadths above the pubic symphysis. The client reports nausea, vomiting, and scant dark brown vaginal discharge. What action should the nurse take?

• A. Collect a urine sample for urinalysis.
• B. Measure vital signs.
• C. Recommend bed rest.
• D. Obtain human chorionic gonadotropin levels.

Correct answer: D

Rationale: In a pregnant client with a fundal height greater than expected at 10 weeks and experiencing scant dark brown vaginal discharge, there is a concern for a molar pregnancy. Assessing human chorionic gonadotropin (hCG) levels is crucial in this situation to confirm or rule out this condition.

3. A new mother who is breastfeeding her 4-week-old infant and has type 1 diabetes reports that her insulin needs have decreased since the birth of her child. Which action should the nurse implement?

• A. Inform her that a decreased need for insulin occurs while breastfeeding.
• B. Counsel her to increase her caloric intake.
• C. Advise the client to breastfeed more frequently.
• D. Schedule an appointment for the client with the diabetic nurse educator.

Correct answer: A

Rationale: The correct answer is A. During breastfeeding, insulin needs often decrease due to the metabolic demands of milk production. Therefore, the nurse should inform the client that this decrease in insulin requirements is a normal response to breastfeeding. Choice B is incorrect as increasing caloric intake is not directly related to the decrease in insulin needs during breastfeeding. Choice C is incorrect as advising the client to breastfeed more frequently does not address the issue of decreased insulin needs. Choice D is incorrect as scheduling an appointment with the diabetic nurse educator is not necessary at this point since the decreased need for insulin is a common physiological response to breastfeeding.

4. Why is complete bedrest necessary for a pregnant client with mitral stenosis Class III?

• A. Complete bedrest decreases oxygen needs and demands on the heart muscle tissue.
• B. We want your baby to be healthy, and this is the only way we can ensure that will happen.
• C. I know you're upset. Would you like to talk about some activities you could do while in bed?
• D. Labor is difficult, and you need to use this time to rest before assuming child-caring duties.

Correct answer: A

Rationale: Complete bedrest is necessary for a pregnant client with mitral stenosis Class III to reduce the workload on the heart, lower oxygen consumption, and prevent complications associated with cardiac conditions like mitral stenosis. By remaining in bed, the client can help maintain cardiac function and promote a safer pregnancy outcome. Choice B is incorrect as it does not provide a specific reason related to the client's medical condition. Choice C is not addressing the medical necessity of bedrest for this particular client. Choice D is irrelevant and does not explain the importance of bedrest for a pregnant client with mitral stenosis Class III.

5. A client receiving oxytocin (Pitocin) to augment early labor. Which assessment is most important for the nurse to obtain each time the infusion rate is increased?

• A. Pain level
• B. Blood pressure
• C. Infusion site
• D. Contraction pattern

Correct answer: D

Rationale: When a client is receiving oxytocin to augment labor, the most crucial assessment for the nurse to obtain each time the infusion rate is increased is monitoring the contraction pattern. Increasing the infusion rate of oxytocin can lead to stronger and more frequent contractions, which can have implications for both the mother and the baby. Monitoring the contraction pattern helps ensure the safe administration of oxytocin and allows for timely interventions if needed.

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