Nursing Elites

1. A newborn with a respiratory rate of 40 breaths per minute at one minute after birth is demonstrating cyanosis of the hands and feet. What action should a nurse take?

• A. Assess bowel sounds.
• B. Continue to monitor.
• C. Assist with intubation.
• D. Rub the infant's back.

Correct answer: B

Rationale: Cyanosis of the hands and feet, known as acrocyanosis, is common in newborns shortly after birth and usually resolves on its own. It is not indicative of a need for immediate intervention. Therefore, the appropriate action is to continue monitoring the newborn's condition. Assessing bowel sounds (Choice A) is not relevant to the presenting issue of cyanosis and respiratory rate. Assisting with intubation (Choice C) is an invasive procedure that is not warranted based on the information provided. Rubbing the infant's back (Choice D) is not necessary for acrocyanosis and could potentially disturb the newborn.

2. A nurse is reviewing laboratory results for a term newborn who is 24 hours old. Which of the following results require intervention by the nurse?

• A. WBC count 10,000/mm3
• B. Platelets 180,000/mm3
• C. Hemoglobin 20g/dL
• D. Glucose 20 mg/dL

Correct answer: D

Rationale: A glucose level of 20 mg/dL is critically low for a newborn and requires immediate intervention. Hypoglycemia in a newborn can lead to serious complications such as neurologic deficits. The normal range for glucose levels in a newborn is typically 40-60 mg/dL. Choices A, B, and C represent normal or acceptable values for a term newborn and do not require immediate intervention. A WBC count of 10,000/mm3, platelets of 180,000/mm3, and hemoglobin of 20g/dL are all within normal ranges for a term newborn and do not raise immediate concerns.

3. A client at 27 weeks of gestation with preeclampsia is being assessed by a nurse. Which of the following findings should the nurse report to the provider?

• A. Urine protein concentration of 200 mg/24 hr.
• B. Creatinine level of 0.8 mg/dL
• C. Hemoglobin level of 14.8 g/dL
• D. Platelet count of 60,000/mm3

Correct answer: D

Rationale: A platelet count of 60,000/mm3 is significantly low and can indicate HELLP syndrome, a severe complication of preeclampsia that involves hemolysis, elevated liver enzymes, and low platelet count. HELLP syndrome requires prompt medical intervention to prevent serious maternal and fetal complications. The other findings listed are within normal limits or not directly related to the severe condition associated with HELLP syndrome.

4. Which field of biology studies heredity?

• A. Etiology.
• B. Ecology.
• C. Genetics.
• D. Eugenics.

Correct answer: C

Rationale: Genetics is the branch of biology that focuses on the study of heredity and variation in organisms. Etiology (choice A) deals with the causes of diseases, not heredity. Ecology (choice B) is concerned with the relationships between organisms and their environment, not specifically heredity. Eugenics (choice D) is a controversial field that involves improving the genetic quality of the human population through selective breeding, which is different from the study of heredity itself.

5. A woman at 26 weeks of gestation is being assessed to determine whether she is experiencing preterm labor. Which finding indicates that preterm labor is occurring?

• A. Estriol is not found in maternal saliva.
• B. Irregular, mild uterine contractions occur every 12 to 15 minutes.
• C. Fetal fibronectin is present in vaginal secretions.
• D. The cervix is effacing and dilated to 2 cm.

Correct answer: D

Rationale: The correct answer is D. Cervical changes such as effacement and dilation to 2 cm are strong indicators of imminent preterm labor. These changes, combined with regular contractions, can signify labor at any gestation. Estriol can be detected in maternal plasma as early as 9 weeks of gestation. Levels of salivary estriol have been linked to preterm birth. Irregular, mild contractions occurring every 12 to 15 minutes without cervical change are generally not concerning. While the presence of fetal fibronectin in vaginal secretions between 24 and 36 weeks of gestation may predict preterm labor, its predictive value is limited (20%-40%). Therefore, cervical changes provide more reliable information regarding the risk of preterm labor.

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