Nursing Elites

1. A healthcare professional is assisting with the care of a client who is receiving IV magnesium sulfate. Which of the following medications should the healthcare professional anticipate administering if magnesium sulfate toxicity is suspected?

• A. Nifedipine
• B. Pyridoxine
• C. Ferrous sulfate
• D. Calcium gluconate

Correct answer: D

Rationale: Calcium gluconate is the antidote for magnesium sulfate toxicity. In cases of magnesium sulfate toxicity, calcium gluconate is administered to counteract the effects of magnesium and restore calcium levels. Magnesium toxicity can lead to symptoms such as muscle weakness, respiratory depression, and cardiac arrhythmias. Calcium gluconate helps in reversing these effects by competing with magnesium and preventing its adverse manifestations. Nifedipine is a calcium channel blocker used for conditions like hypertension and angina, not for magnesium toxicity. Pyridoxine is vitamin B6 and is not the antidote for magnesium toxicity. Ferrous sulfate is an iron supplement and is not used to treat magnesium sulfate toxicity.

2. During a weekly prenatal visit, a nurse is assessing a client at 38 weeks of gestation. Which of the following findings should the nurse report to the provider?

• A. Blood pressure 136/88 mm Hg
• B. Report of insomnia
• C. Weight gain of 2.2 kg (4.8 lb)
• D. Report of Braxton-Hicks contractions

Correct answer: C

Rationale: A weight gain of 2.2 kg (4.8 lb) in a week is above the expected reference range for a client at 38 weeks of gestation and could indicate complications such as preeclampsia or gestational hypertension. Rapid weight gain at this stage requires immediate attention and should be reported to the provider for further evaluation and management. Choices A, B, and D are not the priority findings to report to the provider at this stage of gestation. Blood pressure of 136/88 mm Hg is within normal limits in pregnancy, insomnia is common in the third trimester, and Braxton-Hicks contractions are expected in the third trimester as the body prepares for labor.

3. A client who is at 6 weeks of gestation is being educated about common discomforts of pregnancy. Which of the following findings should the individual include? (Select all that apply)

• A. Breast tenderness
• B. Urinary frequency
• C. Epistaxis
• D. All of the above

Correct answer: D

Rationale: During early pregnancy, common discomforts include breast tenderness due to hormonal changes, urinary frequency caused by increased blood flow to the kidneys, and epistaxis (nosebleeds) due to increased blood volume and hormonal changes. Educating the client about these discomforts helps them understand what to expect during this stage. Choice D, 'All of the above,' is the correct answer because all the listed findings are common discomforts experienced during early pregnancy. Choices A, B, and C are individually correct as well, as breast tenderness, urinary frequency, and epistaxis are all common discomforts that pregnant individuals may encounter.

4. 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.

5. A caregiver is being taught about bottle feeding a newborn. Which of the following statements by the caregiver indicates a need for further instruction?

• A. I will keep the baby's head elevated while feeding.
• B. I will allow the baby to burp several times during each feeding.
• C. I will tilt the bottle to prevent air from entering as the baby sucks.
• D. My baby will have soft, formed yellow stools.

Correct answer: C

Rationale: Tilting the bottle to prevent air from entering as the baby sucks can lead to the baby swallowing air, causing discomfort and potential issues like colic or gas. The correct way to bottle-feed a newborn is by ensuring that the nipple is always filled with milk to avoid air intake, which can lead to problems. Keeping the baby's head elevated while feeding helps prevent choking, allowing the baby to burp several times during each feeding helps release swallowed air, and soft, formed yellow stools indicate a healthy digestion process in newborns.

Similar Questions