Nursing Elites

1. A mother spontaneously delivers a newborn infant in the taxicab while on the way to the hospital. The emergency room nurse reported the mother has active herpes (HSV II) lesions on the vulva. Which intervention should the nurse implement first when admitting the neonate to the nursery?

• A. Document the newborn's temperature on the flow sheet.
• B. Place the newborn in the isolation area of the nursery.
• C. Obtain a blood specimen for a serum glucose level.
• D. Administer the vitamin K injection.

Correct answer: B

Rationale: Newborns exposed to active herpes lesions are at high risk for neonatal herpes, which can be severe. Placing the newborn in isolation is crucial as it helps prevent the spread of the virus and allows for close monitoring. Documenting the newborn's temperature, obtaining a blood specimen for a serum glucose level, and administering the vitamin K injection are important interventions but are not the priority when dealing with a potential infectious risk like neonatal herpes.

2. Examination reveals that the laboring client's cervix is dilated to 2 centimeters, 70% effaced with the presenting part at -2 station. The client tells the nurse, 'I need my epidural now, this hurts.' The nurse's response to the client is based on which information?

• A. The client will need to be catheterized before the epidural can be administered.
• B. Administering an epidural at this point would slow down the labor process.
• C. The client should be dilated to at least 8 centimeters before receiving an epidural.
• D. The baby needs to be at a zero station before an epidural can be administered.

Correct answer: B

Rationale: Administering an epidural too early in labor, especially at 2 cm dilation, can slow down the progress of labor. It is usually recommended to wait until labor is more established. Choice A is incorrect because catheterization is not a prerequisite for epidural administration. Choice C is incorrect as waiting until 8 cm dilation is not a standard requirement for epidural administration. Choice D is incorrect because the baby's station being at zero is not a strict criterion for epidural administration.

3. According to a study in 2013 by van Gameren-Oosterom, individuals with Down syndrome:

• A. are unlikely to die from cardiovascular problems by middle age.
• B. have no specific characteristic features.
• C. show deficits in cognitive development.
• D. are likely to have only 46 chromosomes.

Correct answer: C

Rationale: The correct answer is C. According to a study in 2013 by van Gameren-Oosterom, individuals with Down syndrome often exhibit deficits in cognitive development. This is a common characteristic of Down syndrome, along with other health challenges. Choice A is incorrect because individuals with Down syndrome are at a higher risk of cardiovascular problems, contrary to being unlikely to die from them. Choice B is incorrect as Down syndrome is associated with specific characteristic features such as distinctive facial characteristics, making the statement that they have no specific features incorrect. Choice D is incorrect as individuals with Down syndrome have an extra copy of chromosome 21, resulting in a total of 47 chromosomes, not 46.

4. After mitosis, the genetic code is identical in new cells unless _________ occur through radiation or other environmental influences.

• A. reductions
• B. expulsions
• C. conceptions
• D. mutations

Correct answer: D

Rationale: After mitosis, the genetic code is typically preserved and remains identical in the new cells. However, mutations can occur due to radiation or environmental influences, leading to changes in the DNA sequence and potentially altering the genetic code. Therefore, the correct answer is 'mutations.' Choices A, B, and C are incorrect because reductions, expulsions, and conceptions do not accurately describe the changes in the genetic code that can result from external factors. Mutations are the only option that reflects the alteration in the genetic code caused by external influences, making it the correct choice in this context.

5. A woman gave birth to a 7-pound, 6-ounce infant girl 1 hour ago. The birth was vaginal and the estimated blood loss (EBL) was 1500 ml. When evaluating the woman’s vital signs, which finding would be of greatest concern to the nurse?

• A. Temperature 37.9°C, heart rate 120 beats per minute (bpm), respirations 20 breaths per minute, and blood pressure 90/50 mm Hg.
• B. Temperature 37.4°C, heart rate 88 bpm, respirations 36 breaths per minute, and blood pressure 126/68 mm Hg.
• C. Temperature 38°C, heart rate 80 bpm, respirations 16 breaths per minute, and blood pressure 110/80 mm Hg.
• D. Temperature 36.8°C, heart rate 60 bpm, respirations 18 breaths per minute, and blood pressure 140/90 mm Hg.

Correct answer: A

Rationale: An estimated blood loss (EBL) of 1500 ml following a vaginal birth is significant and can lead to hypovolemia. The vital signs provided in option A (Temperature 37.9°C, heart rate 120 bpm, respirations 20 breaths per minute, and blood pressure 90/50 mm Hg) indicate tachycardia and hypotension, which are concerning signs of hypovolemia due to excessive blood loss. Tachycardia is the body's compensatory mechanism to maintain cardiac output in response to decreased blood volume, and hypotension indicates inadequate perfusion. Options B, C, and D do not exhibit the same level of concern for hypovolemia. Option B shows tachypnea, which can be a result of pain or anxiety postpartum. Option C and D have vital signs within normal limits, which are not indicative of the body's response to significant blood loss.

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