Nursing Elites

1. 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.

2. A client at 37 weeks gestation presents to labor and delivery with contractions every two minutes. The nurse observes several shallow small vesicles on her pubis, labia, and perineum. The nurse should recognize the client is exhibiting symptoms of which condition?

• A. Genital Warts
• B. Syphilis
• C. Herpes Simplex Virus
• D. German Measles

Correct answer: C

Rationale: The correct answer is C: Herpes Simplex Virus (HSV). HSV can present with small vesicles on the genital area, and it is a concern during labor due to the risk of transmission to the newborn. Genital warts (Choice A) are caused by the human papillomavirus (HPV) and typically present as flesh-colored growths, not vesicles. Syphilis (Choice B) manifests as painless sores and can have systemic effects but does not typically present with vesicles. German measles (Choice D), also known as Rubella, is a viral illness characterized by a red rash, fever, and lymphadenopathy, not vesicles.

3. Twins that derive from a single zygote that has split into two are called:

• A. monozygotic (MZ) twins.
• B. fraternal twins.
• C. non-identical twins.
• D. dizygotic (DZ) twins.

Correct answer: A

Rationale: The correct answer is A: monozygotic (MZ) twins. Monozygotic twins, also known as identical twins, occur when a single zygote splits into two embryos, leading to two genetically identical individuals. Choice B, fraternal twins, are twins that develop from two separate eggs fertilized by two different sperm cells, resulting in non-identical siblings. Choice C, non-identical twins, is not a common term used to describe this type of twinning. Choice D, dizygotic (DZ) twins, refer to twins that develop from two separate eggs fertilized by two different sperm cells, leading to non-identical twins.

4. After meiosis, each new cell nucleus contains _____ chromosomes.

• A. 46
• B. 35
• C. 23
• D. 12

Correct answer: C

Rationale: After meiosis, each resulting cell contains 23 chromosomes. Meiosis is a process that involves two sequential divisions resulting in four daughter cells, each with half the number of chromosomes as the parent cell. In humans, the parent cell has 46 chromosomes (diploid), and after meiosis, the resulting cells (sperm or ova) have 23 chromosomes (haploid). Choice A (46 chromosomes) is incorrect because this is the number of chromosomes in a human diploid cell before meiosis. Choices B (35 chromosomes) and D (12 chromosomes) are incorrect as they do not represent the correct number of chromosomes after meiosis in human cells.

5. A 25-year-old gravida 3, para 2 client gave birth to a 9-pound, 7-ounce boy 4 hours ago after augmentation of labor with oxytocin (Pitocin). She presses her call light and asks for her nurse right away, stating 'I’m bleeding a lot.' What is the most likely cause of postpartum hemorrhage in this client?

• A. Retained placental fragments.
• B. Unrepaired vaginal lacerations.
• C. Uterine atony.
• D. Puerperal infection.

Correct answer: C

Rationale: Uterine atony is the most likely cause of bleeding 4 hours after delivery, especially after delivering a macrosomic infant and augmenting labor with oxytocin. Uterine atony is characterized by the inability of the uterine muscles to contract effectively after childbirth, leading to excessive bleeding. The other options, such as retained placental fragments (A), unrepaired vaginal lacerations (B), and puerperal infection (D), are less likely causes of postpartum hemorrhage in this scenario. Retained placental fragments can cause bleeding, but this typically presents earlier than 4 hours postpartum. Unrepaired vaginal lacerations would likely be evident sooner and not typically result in significant bleeding. Puerperal infection is not a common cause of immediate postpartum hemorrhage unless there are other signs of infection present.

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