Nursing Elites

1. A nurse is assessing a newborn who is 48 hours old and has a maternal history of methadone use during pregnancy. Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

• A. Hyporeactivity
• B. Excessive high-pitched cry
• C. Acrocyanosis
• D. Respiratory rate of 50/min

Correct answer: B

Rationale: An excessive high-pitched cry is a classic sign of neonatal abstinence syndrome, indicating withdrawal from substances such as methadone. Neonates with neonatal abstinence syndrome often display irritability, tremors, and feeding difficulties. Hyporeactivity, acrocyanosis, and a respiratory rate of 50/min are not typical manifestations of neonatal abstinence syndrome. Hyporeactivity is more associated with conditions like hypothyroidism or sepsis, acrocyanosis is a common finding in newborns due to immature peripheral circulation, and a respiratory rate of 50/min is within the normal range for a newborn.

2. A client who is at 32 weeks gestation and has a history of cardiac disease is being cared for by a nurse. Which of the following positions should the nurse place the client in to best promote optimal cardiac output?

• A. The chest
• B. Standing
• C. Supine
• D. Left lateral

Correct answer: D

Rationale: The correct answer is the left lateral position. Placing the client in the left lateral position promotes optimal cardiac output during pregnancy by reducing pressure on the inferior vena cava, improving blood flow to the heart and fetus. Choice A, 'The chest,' is incorrect as it does not describe a position that benefits cardiac output. Choice B, 'Standing,' is incorrect as it does not alleviate pressure on the vena cava. Choice C, 'Supine,' is contraindicated in pregnancy, especially in clients with cardiac disease, as it can compress the vena cava and decrease cardiac output.

3. A nurse is teaching a client about the dietary management of irritable bowel syndrome (IBS). Which of the following instructions should the nurse include?

• A. Decrease fiber intake
• B. Drink peppermint tea
• C. Increase foods that are high in fat
• D. Avoid foods with gluten

Correct answer: B

Rationale: The correct answer is B: 'Drink peppermint tea.' Peppermint tea can help relax the smooth muscles of the gastrointestinal tract, reducing symptoms of IBS, such as bloating and abdominal discomfort. Choices A, C, and D are incorrect. Decreasing fiber intake is not recommended for IBS management as fiber can help regulate bowel movements. Increasing foods high in fat can exacerbate symptoms of IBS, as high-fat foods can be harder to digest. Avoiding foods with gluten is more relevant for individuals with gluten sensitivity or celiac disease, not specifically for IBS management.

4. A nurse is providing discharge teaching to a client following a heart transplant. Which of the following information should the nurse include in the teaching?

• A. Immunosuppressant medications need to be taken for up to 1 year
• B. Shortness of breath might be an indication of transplant rejection
• C. The surgical site will heal in 3 to 4 weeks after surgery
• D. Begin 45 minutes of moderate aerobic exercise per day following discharge

Correct answer: B

Rationale: The correct answer is B because shortness of breath is an indication of transplant rejection, along with other manifestations like fatigue, edema, bradycardia, and hypotension. Choice A is incorrect because immunosuppressant medications are usually taken for life to prevent rejection. Choice C is incorrect as the surgical site may take longer to heal fully. Choice D is incorrect as the initiation of exercise post-heart transplant should be gradual and individualized based on the client's condition.

5. A nurse is obtaining the medical history of a client who has a new prescription for isosorbide mononitrate. Which of the following should the nurse identify as a contraindication to this medication?

• A. Glaucoma
• B. Hypertension
• C. Polycythemia
• D. Migraine headaches

Correct answer: A

Rationale: Isosorbide mononitrate is contraindicated in clients with glaucoma due to its potential to increase intraocular pressure, which can exacerbate the condition. Hypertension, polycythemia, and migraine headaches are not contraindications for isosorbide mononitrate. In fact, isosorbide mononitrate is commonly used in the management of hypertension and certain types of angina.

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