Nursing Elites

1. A client who is at 42 weeks gestation and in labor asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make?

• A. Your baby will have excess baby fat.
• B. Your baby will have flat areola without breast buds.
• C. Your baby's heels will easily move to his ears.
• D. Your baby's skin will have a leathery appearance.

Correct answer: D

Rationale: The correct answer is D: 'Your baby's skin will have a leathery appearance.' Postmature infants, born after 42 weeks of gestation, may have a leathery appearance of the skin due to prolonged exposure to amniotic fluid. This occurs as the protective vernix caseosa is shed, and the skin loses its protective covering, leading to a wrinkled and dry appearance. Choices A, B, and C are incorrect. Excess baby fat is not a typical characteristic of postmature infants. Flat areola without breast buds and the ability of the baby's heels to easily move to his ears are not associated with postmaturity.

2. A newborn who was born at 38 weeks of gestation, weighs 3,200 g, and is in the 60th percentile for weight should be classified as which of the following?

• A. Low birth weight
• B. Appropriate for gestational age
• C. Small for gestational age
• D. Large for gestational age

Correct answer: B

Rationale: The classification of a newborn as appropriate for gestational age is determined by considering the weight and gestational age. In this case, the newborn's weight falls within the normal range for the gestational age, indicating that the newborn is appropriately sized for the length of time spent in the womb. Choice A, 'Low birth weight,' is incorrect as the newborn's weight is within the normal range. Choice C, 'Small for gestational age,' is incorrect because the newborn's weight is not below the 10th percentile for gestational age. Choice D, 'Large for gestational age,' is incorrect as the newborn's weight is not above the 90th percentile, rather falling within the 60th percentile which is considered normal.

3. A client is in the first trimester of pregnancy and lacks immunity to rubella. When should the client receive rubella immunization?

• A. Shortly after giving birth
• B. In the third trimester
• C. Immediately
• D. During the next attempt to get pregnant

Correct answer: A

Rationale: Rubella immunization is recommended shortly after giving birth for a pregnant individual who lacks immunity. This timing ensures the client is protected from rubella in future pregnancies. Administering the vaccine postpartum allows the body to develop immunity without posing any risk to the developing fetus during pregnancy. Option B is incorrect because administering the rubella vaccine in the third trimester can potentially expose the developing fetus to the live virus, which is not recommended. Option C is incorrect as there is a preferred timing for rubella immunization in this scenario. Option D is incorrect as waiting until the next attempt to get pregnant does not protect the current pregnancy from rubella exposure.

4. A client in the delivery room just delivered a newborn, and the nurse is planning to promote parent-infant bonding. What should the nurse prioritize?

• A. Encourage the parents to touch and explore the newborn's features
• B. Limit noise and interruptions in the delivery room
• C. Place the newborn at the client's breast
• D. Position the newborn skin-to-skin on the client's chest

Correct answer: D

Rationale: Positioning the newborn skin-to-skin on the client's chest is the priority action to promote warmth, regulate the newborn's heart rate and breathing, and enhance parent-infant bonding. This method facilitates early bonding, stabilizes the baby's temperature, and encourages breastfeeding initiation. Encouraging parents to touch and explore the newborn's features is important but not the priority at this moment. Limiting noise and interruptions can be beneficial but not as crucial as skin-to-skin contact for bonding. Placing the newborn at the client's breast is essential for breastfeeding but should come after the initial skin-to-skin contact for bonding and temperature regulation.

5. A healthcare professional in a provider's office is reviewing the medical record of a client who is in her first trimester of pregnancy. Which of the following findings should the healthcare professional identify as a risk factor for the development of preeclampsia?

• A. Singleton pregnancy
• B. BMI of 20
• C. Maternal age of 32 years
• D. Pregestational diabetes mellitus

Correct answer: D

Rationale: Pregestational diabetes mellitus is a significant risk factor for the development of preeclampsia in pregnant individuals. Preeclampsia is more common in women with preexisting conditions such as diabetes, hypertension, renal disease, lupus, or rheumatoid arthritis. Singleton pregnancy, a BMI of 20, or maternal age of 32 years are not considered significant risk factors for developing preeclampsia.

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