Nursing Elites

1. A client at 18-weeks gestation was informed this morning that she has an elevated alpha-fetoprotein (AFP) level. After the healthcare provider leaves the room, the client asks what she should do next. What information should the nurse provide?

• A. Inform her that a repeat alpha-fetoprotein (AFP) should be evaluated.
• B. Discuss options for intrauterine surgical correction of congenital defects.
• C. Reassure the client that the AFP results are likely to be a false reading.
• D. Explain that a sonogram should be scheduled for definitive results.

Correct answer: D

Rationale: An elevated alpha-fetoprotein (AFP) level in a pregnant client can indicate potential congenital anomalies in the fetus. A follow-up sonogram is necessary to provide definitive results and further evaluate the fetus for any possible abnormalities. Therefore, it is essential for the nurse to explain to the client that scheduling a sonogram is the next appropriate step to assess the fetal well-being and address any concerns regarding the elevated AFP level. Choices A, B, and C are incorrect because a repeat AFP test alone, discussing surgical correction of defects, or assuming the results are false without further evaluation are not appropriate responses when dealing with a potentially serious issue like elevated AFP levels in pregnancy.

2. A primipara patient asks what is the best pet to have at home to share time with. Which pet is not recommended?

• A. Dog
• B. Cat
• C. Bird
• D. Fish

Correct answer: C

Rationale: Birds are not recommended as pets for a primipara patient due to potential health risks associated with bird droppings, feathers, and dander. These factors may pose a risk to the newborn's health and the mother's well-being. Additionally, some birds can be loud, which may disrupt the baby's sleep patterns. Therefore, it is advisable for primipara patients to consider pets like dogs, cats, or fish as they generally have lower associated risks in a household with a newborn. Dogs, cats, and fish are relatively safer options compared to birds for primipara patients due to their lower risk of transmitting infections, allergens, or causing disturbances that could affect the newborn or the mother.

3. During a prenatal visit, the nurse discusses with a client the effects of smoking on the fetus. When compared with nonsmokers, mothers who smoke during pregnancy tend to produce infants who have

• A. lower Apgar scores.
• B. lower birth weights.
• C. respiratory distress.
• D. a higher rate of congenital anomalies.

Correct answer: B

Rationale: Smoking during pregnancy is associated with intrauterine growth restriction, leading to lower birth weights. This occurs due to the harmful effects of smoking on fetal development, which can result in reduced nutrient and oxygen supply to the fetus, impacting its overall growth and leading to lower birth weights. Choices A, C, and D are incorrect as smoking during pregnancy primarily affects fetal growth and development, leading to lower birth weights rather than lower Apgar scores, respiratory distress, or a higher rate of congenital anomalies.

4. Immediately after birth, a newborn infant is suctioned, dried, and placed under a radiant warmer. The infant has spontaneous respirations, and the nurse assesses an apical heart rate of 80 beats/minute and respirations of 20 breaths/minute. What action should the nurse take next?

• A. Initiate positive pressure ventilation.
• B. Intervene after the one-minute Apgar assessment.
• C. Initiate CPR on the infant.
• D. Assess the infant's blood glucose level.

Correct answer: A

Rationale: A heart rate below 100 bpm in a newborn indicates bradycardia and requires intervention. Positive pressure ventilation should be initiated to improve oxygenation and help increase the infant's heart rate. This intervention is crucial to support the newborn's transition to extrauterine life and prevent further complications.

5. The healthcare provider is preparing to suture a 10-year-old with a lacerated forehead. Both parents and the 12-year-old sibling are at the child’s bedside. Which instruction best supports the family?

• A. While waiting for the healthcare provider, only one family member may stay with the child.
• B. All family members should leave while the healthcare provider sutures the child’s forehead.
• C. It is best if the sibling goes to the waiting room until the suturing is completed.
• D. Please decide among yourselves who will stay when the healthcare provider begins suturing.

Correct answer: D

Rationale: Choice D is the best instruction as it involves the family in the decision-making process, allowing them to choose who will stay with the child during the suturing procedure. This approach supports the family's comfort and participation in the child's care, promoting a sense of control and family-centered care. Choices A, B, and C do not promote family involvement and may lead to feelings of exclusion or lack of control among the family members.

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