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. Rico is a man who has enlarged breasts and suffers from mild mental retardation. He has a problem learning languages, and his body produces less of the male sex hormone testosterone than normal males. Rico is most likely suffering from:

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

Correct answer: A

Rationale: Rico's symptoms align with Klinefelter syndrome, which is characterized by an extra X chromosome in males (XXY). Enlarged breasts (gynecomastia), mild mental retardation, learning difficulties, and reduced testosterone production are common features of Klinefelter syndrome. Choice B, Tay-Sachs disease, is a genetic disorder that affects the nervous system and is not associated with the symptoms described. Choice C, Turner syndrome, occurs in females with a missing or partially missing X chromosome and does not fit Rico's profile. Choice D, Down syndrome, is caused by an extra copy of chromosome 21 and typically does not present with the symptoms mentioned for Rico.

3. A multiparous client at 36 hours postpartum reports increased bleeding and cramping. On examination, the nurse finds the uterine fundus 2 centimeters above the umbilicus. Which action should the nurse take first?

• A. Increase the intravenous fluid to 150 ml/hr.
• B. Call the healthcare provider.
• C. Encourage the client to void.
• D. Administer ibuprofen 800 milligrams by mouth.

Correct answer: C

Rationale: Encouraging the client to void is the priority action in this scenario. A distended bladder can prevent the uterus from contracting properly, leading to increased bleeding and a high uterine fundus. By encouraging the client to void, the nurse can help the uterus contract effectively, reducing bleeding. Increasing intravenous fluids or administering ibuprofen would not address the immediate concern of a distended bladder affecting uterine contraction. While it may be necessary to involve the healthcare provider, addressing the bladder distention promptly is crucial to prevent further complications.

4. A primiparous woman presents in labor with the following labs: hemoglobin 10.9 g/dL, hematocrit 29%, hepatitis surface antigen positive, Group B Streptococcus positive, and rubella non-immune. Which intervention should the nurse implement?

• A. Transfuse 2 units of packed red blood cells.
• B. Give measles, mumps, rubella vaccine 0.5 mL.
• C. Administer ampicillin 2 grams intravenously.
• D. Inject hepatitis B immune globulin 0.5 milliliters.

Correct answer: C

Rationale: The correct intervention in this scenario is to administer ampicillin 2 grams intravenously. This is crucial to prevent Group B Streptococcus infection in the newborn during delivery. Option A, transfusing packed red blood cells, is not indicated based on the hemoglobin and hematocrit levels provided. Option B, giving measles, mumps, rubella vaccine, is not necessary at this time. Option D, injecting hepatitis B immune globulin, is not appropriate for the conditions presented in the question.

5. Females with Turner syndrome:

• A. possess more thymine than cytosine.
• B. are taller than average.
• C. produce little estrogen.
• D. are more likely to give birth to twins.

Correct answer: C

Rationale: Turner syndrome is a chromosomal disorder in females characterized by short stature and underdeveloped ovaries, resulting in low estrogen production. This leads to symptoms such as delayed puberty and infertility. Choice A is incorrect because the chromosomal abnormality in Turner syndrome does not affect the thymine-cytosine ratio. Choice B is incorrect as females with Turner syndrome are typically shorter than average. Choice D is incorrect as Turner syndrome does not increase the likelihood of giving birth to twins.

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