Nursing Elites

1. During preterm labor, a client is scheduled for an amniocentesis. The nurse should review which of the following tests to assess fetal lung maturity?

• A. Alpha-fetoprotein (AFP)
• B. Lecithin/sphingomyelin (L/S) ratio
• C. Kleihauer-Betke test
• D. Indirect Coombs' test

Correct answer: B

Rationale: The Lecithin/sphingomyelin (L/S) ratio is a test used to evaluate fetal lung maturity. An L/S ratio greater than 2:1 indicates fetal lung maturity. This test helps in determining the risk of respiratory distress syndrome in the newborn. Alpha-fetoprotein (AFP) is used in screening for neural tube defects, not for assessing lung maturity. The Kleihauer-Betke test is used to detect fetal-maternal hemorrhage, not fetal lung maturity. The Indirect Coombs' test is used to identify the presence of antibodies in the mother's blood that could attack fetal red blood cells, not for assessing lung maturity.

2. A parent is receiving discharge teaching from a nurse regarding caring for their newborn after a circumcision. Which instruction should the nurse include?

• A. Apply slight pressure with a sterile gauze pad for mild bleeding.
• B. Inspect the circumcision site every 6 to 8 hours.
• C. Avoid using baby wipes containing alcohol to cleanse the penis with each diaper change.
• D. Clean the circumcision site daily using a warm, wet washcloth.

Correct answer: A

Rationale: The correct answer is to apply slight pressure with a sterile gauze pad for mild bleeding. This helps to stop bleeding. If the bleeding persists, the parent should contact the healthcare provider for further guidance. While inspecting the circumcision site is important, checking every 6 to 8 hours might be too frequent and could disrupt healing. Using baby wipes containing alcohol can irritate the sensitive skin, so it is advised to avoid them. Cleaning the circumcision site daily is crucial, but excessive cleaning by removing yellow exudate daily is not necessary unless advised by the healthcare provider.

3. A newborn is noted to have secretions bubbling out of the nose and mouth after delivery. What is the nurse's priority action?

• A. Suction the nose with a bulb syringe.
• B. Suction the mouth with a bulb syringe.
• C. Use a suction catheter with low negative pressure.
• D. Turn the newborn on their side.

Correct answer: B

Rationale: The priority action for the nurse is to suction the mouth with a bulb syringe. Suctioning the mouth first is crucial to prevent aspiration and ensure the airway is clear, which takes precedence over suctioning the nose. This intervention helps maintain a patent airway and promotes adequate breathing in the newborn. Using a suction catheter with low negative pressure may not be appropriate as the newborn needs a gentle suction method like a bulb syringe. Turning the newborn on their side is important if there is a risk of aspiration, but clearing the mouth of secretions should be the priority to establish a clear airway.

4. A client is postpartum and has idiopathic thrombocytopenic purpura (ITP). Which of the following findings should the nurse expect?

• A. Decreased platelet count
• B. Increased erythrocyte sedimentation rate (ESR)
• C. Decreased megakaryocytes
• D. Increased WBC

Correct answer: A

Rationale: Idiopathic thrombocytopenic purpura (ITP) is characterized by an autoimmune response that leads to a decreased platelet count. This condition increases the risk of bleeding due to the low platelet levels. Monitoring the platelet count is crucial in managing ITP, as it helps determine the risk of bleeding and guides treatment decisions. Therefore, the correct finding to expect in a client with ITP is a decreased platelet count. Choice B, an increased erythrocyte sedimentation rate (ESR), is not typically associated with ITP. Choice C, decreased megakaryocytes, may be seen in conditions like aplastic anemia but are not a typical finding in ITP. Choice D, an increased white blood cell count (WBC), is not a characteristic feature of ITP.

5. A client in active labor is being prepared for epidural analgesia. Which of the following actions should the nurse take?

• A. Have the client sit upright on the bed with legs crossed.
• B. Administer a 500 mL bolus of lactated Ringer's solution prior to induction.
• C. Inform the client that the anesthetic effect will last for approximately 2 hours.
• D. Obtain a 30-minute electronic fetal monitoring (EFM) strip prior to induction.

Correct answer: D

Rationale: Obtaining a 30-minute electronic fetal monitoring (EFM) strip prior to epidural analgesia is crucial to establish a baseline for fetal heart rate and uterine activity. This baseline helps in monitoring fetal well-being during labor and assessing the effect of analgesia on the baby. It enables the healthcare team to identify any changes in the fetal heart rate pattern and uterine contractions, ensuring the safety of both the mother and the baby. Choices A, B, and C are incorrect because having the client sit upright with legs crossed is not necessary for epidural placement, administering a bolus of lactated Ringer's solution is not typically done before epidural analgesia, and the duration of the anesthetic effect varies and is not accurately 2 hours.

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