Nursing Elites

1. A nurse is assisting with an in-service for newly licensed nurses about neonatal abstinence syndrome in newborns. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching?

• A. The newborn will have decreased muscle tone.
• B. The newborn will have a continuous high-pitched cry.
• C. The newborn will sleep for 2 to 3 hours after a feeding.
• D. The newborn will have mild tremors when disturbed.

Correct answer: B

Rationale: The correct answer is B. A continuous high-pitched cry is a characteristic sign of neonatal abstinence syndrome, indicating withdrawal from drugs. Choices A, C, and D are incorrect because decreased muscle tone, sleeping for 2 to 3 hours after a feeding, and mild tremors when disturbed are not specific indicators of neonatal abstinence syndrome.

2. A client in active labor at 39 weeks of gestation is receiving continuous IV oxytocin and has early decelerations in the FHR on the monitor tracing. What action should the nurse take?

• A. Discontinue the oxytocin infusion.
• B. Continue monitoring the client.
• C. Request that the provider assess the client.
• D. Increase the infusion rate of the maintenance IV fluid.

Correct answer: B

Rationale: Early decelerations in the FHR are benign and are typically caused by fetal head compression during contractions. In this case, with the client at 39 weeks of gestation and on oxytocin, it is important for the nurse to continue monitoring the client. Early decelerations do not require intervention as they are a normal response to certain stimuli and do not indicate fetal distress. Discontinuing the oxytocin infusion (Choice A) is not necessary as early decelerations are not related to oxytocin administration. Requesting the provider to assess the client (Choice C) is not needed for early decelerations as they are a normal finding. Increasing the infusion rate of the maintenance IV fluid (Choice D) is not indicated and would not address the early decelerations. Therefore, the appropriate action is to continue monitoring the client and reassess as needed.

3. A client in the antepartum unit is at 36 weeks of gestation and has pregnancy-induced hypertension. Suddenly, the client reports continuous abdominal pain and vaginal bleeding. The nurse should suspect which of the following complications?

• A. Placenta previa
• B. Prolapsed cord
• C. Incompetent cervix
• D. Abruptio placentae

Correct answer: D

Rationale: Abruptio placentae is the premature separation of the placenta from the uterine wall, which can cause continuous abdominal pain and vaginal bleeding. In this scenario, the client's symptoms of sudden abdominal pain and vaginal bleeding are indicative of abruptio placentae, which requires immediate medical attention to prevent potential complications for both the client and the fetus. Placenta previa is characterized by painless vaginal bleeding in the third trimester, not sudden abdominal pain. Prolapsed cord presents with visible umbilical cord protruding from the vagina and is not associated with abruptio placentae symptoms. Incompetent cervix typically manifests as painless cervical dilation in the second trimester, not sudden abdominal pain and bleeding as seen in abruptio placentae.

4. 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.

5. A client in labor is having contractions 4 minutes apart. Which of the following patterns should the nurse expect on the fetal monitoring tracing?

• A. Contractions that last for 60 seconds each with a 4-minute rest between contractions
• B. A contraction that lasts 4 minutes followed by a period of relaxation
• C. Contractions that last for 60 seconds each with a 3-minute rest between contractions
• D. Contractions that last 45 seconds each with a 3-minute rest between contractions

Correct answer: C

Rationale: The correct answer is C. When contractions are 4 minutes apart, it means there are 4 minutes from the start of one contraction to the start of the next. If each contraction lasts 60 seconds, there will be a 3-minute rest period between contractions. This allows for adequate uterine relaxation and recovery before the next contraction begins. Choice A is incorrect because it suggests a 4-minute rest between contractions, which is not accurate. Choice B is incorrect as contractions lasting 4 minutes continuously without rest would be concerning. Choice D is incorrect as it suggests 45-second contractions instead of 60-second contractions.

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