Nursing Elites

1. A full-term infant is transferred to the nursery from labor and delivery. Which information is most important for the LPN/LVN to receive when planning immediate care for the newborn?

• A. Length of labor and method of delivery.
• B. Infant's condition at birth and treatment received.
• C. Feeding method chosen by the parents.
• D. History of drugs given to the mother during labor.

Correct answer: B

Rationale: When a full-term infant is transferred to the nursery, the most crucial information for the LPN/LVN to receive for immediate care planning is the infant's condition at birth and any treatments received. This data helps in determining the initial care needs and monitoring requirements for the newborn. Choices A, C, and D are not as critical as the infant's condition at birth and treatment received. The length of labor and method of delivery may provide background information but may not be as essential for immediate care planning. The feeding method chosen by the parents and the history of drugs given to the mother during labor are important but do not take precedence over knowing the infant's condition and treatment received.

2. A couple has been trying to conceive for nine months without success. Which information obtained from the clients is most likely to have an impact on the couple's ability to conceive a child?

• A. Both partners have a daily exercise regimen that includes running four miles each morning.
• B. The couple has a history of having sexual intercourse 2 to 3 times per week.
• C. The woman's menstrual period occurs every 35 days.
• D. They use lubricants with each sexual encounter to decrease friction.

Correct answer: D

Rationale: Using lubricants during sexual encounters can potentially impact the couple's ability to conceive a child. Some lubricants may contain substances that are spermicidal or alter the vaginal environment, affecting sperm motility and fertility.

3. Twenty minutes after a continuous epidural anesthetic is administered, a laboring client's blood pressure drops from 120/80 to 90/60. What action should the healthcare provider take?

• A. Notify the healthcare provider or anesthesiologist immediately.
• B. Continue to assess the blood pressure every 5 minutes.
• C. Place the woman in a lateral position.
• D. Turn off the continuous epidural.

Correct answer: C

Rationale: Placing the woman in a lateral position is the appropriate action to improve venous return and cardiac output, helping to stabilize the blood pressure. This position can alleviate pressure on the inferior vena cava, reducing the risk of hypotension associated with epidural anesthesia. Turning off the continuous epidural would not be the initial action as it may not be necessary and could lead to inadequate pain relief for the client. Notifying the healthcare provider or anesthesiologist immediately is premature and should be done after attempting non-invasive interventions. Continuing to assess the blood pressure every 5 minutes is important, but placing the woman in a lateral position should be the first intervention to address the hypotension.

4. A 5-year-old child is admitted to the pediatric unit with fever and pain secondary to a sickle cell crisis. Which intervention should the nurse implement first?

• A. Obtain a culture of any sputum or wound drainage
• B. Initiate normal saline IV at 50 ml/hr
• C. Administer a loading dose of penicillin IM
• D. Administer the initial dose of folic acid PO

Correct answer: B

Rationale: In a child with a sickle cell crisis, the priority intervention is to initiate normal saline IV at 50 ml/hr to manage dehydration and help alleviate pain. This intervention helps improve hydration status and supports the circulation of sickled red blood cells, reducing the risk of vaso-occlusive episodes and associated pain. Obtaining a culture of any sputum or wound drainage (Choice A) may be necessary but is not the initial priority. Administering a loading dose of penicillin IM (Choice C) is important but not the first intervention. Administering the initial dose of folic acid PO (Choice D) is beneficial but does not address the immediate need for hydration in a sickle cell crisis.

5. A postpartum client who is Rh-negative refuses to receive RhoGAM after the delivery of an infant who is Rh-positive. Which information should the nurse provide this client?

• A. RhoGAM prevents maternal antibody formation for future Rh-positive babies.
• B. RhoGAM is not necessary unless all of her pregnancies are Rh-positive.
• C. The Rh-positive factor from the fetus threatens her blood cells.
• D. The mother should receive RhoGAM when the baby is Rh-negative.

Correct answer: A

Rationale: The correct answer is A. RhoGAM is administered to Rh-negative individuals after exposure to Rh-positive blood to prevent the development of antibodies that could harm future Rh-positive babies during subsequent pregnancies. By refusing RhoGAM after the delivery of an Rh-positive infant, the mother risks developing these antibodies, which could lead to hemolytic disease in future pregnancies with Rh-positive babies. Therefore, it is crucial for the nurse to explain to the client that receiving RhoGAM prevents the formation of maternal antibodies against Rh-positive blood, safeguarding the health of future babies. Choices B, C, and D are incorrect. Choice B is incorrect because RhoGAM is necessary after exposure to Rh-positive blood, regardless of the Rh status of future pregnancies. Choice C is incorrect as it does not accurately convey the purpose of RhoGAM administration. Choice D is incorrect because RhoGAM is specifically given after exposure to Rh-positive blood, not when the baby is Rh-negative.

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