Nursing Elites

1. A full-term newborn is being assessed by a nurse 15 minutes after birth. Which of the following findings requires intervention by the nurse?

• A. Heart rate 168/min
• B. Respiratory rate 18/min
• C. Tremors
• D. Fine crackles

Correct answer: B

Rationale: A newborn's respiratory rate can vary between 20 to 100 breaths per minute during the initial phase after birth. A respiratory rate as low as 18 breaths per minute at this early stage requires immediate nursing intervention. This finding necessitates further assessment to ensure adequate oxygenation and respiratory function. The other options, heart rate of 168/min, tremors, and fine crackles, are within normal limits for a full-term newborn and do not require immediate intervention.

2. A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow.

• A. Palpate the fundus to identify the fetal part.
• B. Determine the location of the fetal back.
• C. Palpate for the fetal part presenting at the inlet.
• D. All of the Above

Correct answer: D

Rationale: The correct sequence for the nurse to follow when performing Leopold maneuvers is as follows: first, palpate the client's fundus to identify the fetal part, second, determine the location of the fetal back, third, palpate for the fetal part presenting at the inlet, and finally, palpate the cephalic prominence to identify the attitude of the head. Therefore, option D, 'All of the Above,' is the correct answer as it includes all the steps in the correct sequence. Choices A, B, and C are incorrect as they do not represent the complete sequence required for performing Leopold maneuvers.

3. A healthcare professional is assessing four newborns. Which of the following findings should the professional report to the provider?

• A. A newborn who is 26 hours old and has erythema toxicum on their face
• B. A newborn who is 32 hours old and has not passed meconium stool
• C. A newborn who is 12 hours old and has pink-tinged urine
• D. A newborn who is 18 hours old and has an axillary temperature of 37.7° C (99.9° F)

Correct answer: D

Rationale: An axillary temperature greater than 37.5° C (99.5° F) is above the expected reference range for a newborn and can be an indication of sepsis. Therefore, the healthcare professional should report this finding to the provider for further evaluation and management to rule out sepsis. Choices A, B, and C are within the expected range of normal findings for newborns. Erythema toxicum is a common and benign rash in newborns, not requiring immediate reporting. Not passing meconium stool within the first 24-48 hours can be normal, and pink-tinged urine can be due to uric acid crystals excretion, which is also common in newborns.

4. During an assessment, a healthcare provider observes small pearly white nodules on the roof of a newborn's mouth. This finding is a characteristic of which of the following conditions?

• A. Mongolian spots
• B. Milia spots
• C. Erythema toxicum
• D. Epstein's pearls

Correct answer: D

Rationale: Epstein's pearls are small pearly white nodules commonly observed on the roof of a newborn's mouth. They are considered a normal finding and typically disappear without treatment. It is essential for healthcare providers to recognize these benign nodules to differentiate them from other conditions and provide appropriate education to parents. The other choices are incorrect: A) Mongolian spots are blue or purple birthmarks commonly found on the skin; B) Milia spots are tiny white bumps on a newborn's nose and face; C) Erythema toxicum presents as a rash of flat red splotches with small bumps that can appear on a baby's skin.

5. What is the most appropriate statement for a nurse to make to a client who has recently experienced a perinatal death?

• A. It must be a comfort to know you have another child.
• B. I'm sad for you.
• C. There is usually something wrong with the baby.
• D. You will always have an angel in heaven.

Correct answer: B

Rationale: Option B, 'I'm sad for you,' is the most appropriate response for the nurse to make to the client who has experienced a perinatal death. This statement conveys empathy and compassion, acknowledging the client's grief and validating their emotions. It opens the door for the client to express their feelings and facilitates further communication and support from the nurse. Choices A, C, and D are not appropriate in this context. Choice A may come across as dismissive of the client's grief by redirecting the focus to another child. Choice C suggests blame or fault, which is not helpful or accurate in most cases of perinatal death. Choice D, while well-intentioned, may not be comforting to all clients and could impose a specific belief system on the client's experience.

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