Nursing Elites

1. A client has postpartum psychosis. Which of the following actions is the nurse's priority?

• A. Reinforce the importance of taking antipsychotics as prescribed
• B. Ask the client if they have thoughts of harming themselves or their infant
• C. Monitor the infant for signs of failure to thrive
• D. Check the client's medical record for a history of bipolar disorder

Correct answer: B

Rationale: In a situation where a client has postpartum psychosis, the priority action for the nurse is to ask the client if they have thoughts of harming themselves or their infant. This is crucial to assess the risk of harm and ensure the safety of the client and the infant. While reinforcing the importance of taking antipsychotics as prescribed is essential for treatment, safety concerns take precedence. Monitoring the infant for signs of failure to thrive is important for the infant's well-being but is not the priority when the immediate safety of the client and infant is at risk. Checking the client's medical record for a history of bipolar disorder is relevant for understanding the client's medical history but is not the priority when addressing current safety concerns.

2. A nurse is caring for a preterm newborn who is in an incubator to maintain a neutral thermal environment. The father of the newborn asks the nurse why this is necessary. Which of the following responses should the nurse make?

• A. Preterm newborns have a smaller body surface area than normal newborns.
• B. The added brown fat layer in a preterm newborn reduces his ability to generate heat.
• C. Preterm newborns lack adequate temperature control mechanisms.
• D. The heat in the incubator rapidly dries the sweat of preterm newborns.

Correct answer: C

Rationale: The correct answer is C because preterm newborns have immature temperature regulation mechanisms, making it difficult for them to maintain their body temperature. An incubator helps maintain a stable thermal environment. Choice A is incorrect as the body surface area is not the primary reason for needing an incubator. Choice B is incorrect because brown fat in preterm newborns actually helps generate heat. Choice D is incorrect as the purpose of the incubator is not to dry sweat but to regulate the newborn's temperature.

3. When caring for clients in a prenatal clinic, a nurse should report which client's weight gain to the provider?

• A. 1.8 kg (4 lb) weight gain in the first trimester
• B. 3.6 kg (8 lb) weight gain in the first trimester
• C. 6.8 kg (15 lb) weight gain in the second trimester
• D. 11.3 kg (25 lb) weight gain in the third trimester

Correct answer: B

Rationale: A weight gain of 3.6 kg (8 lb) in the first trimester is excessive and should be reported to the provider for further evaluation. Excessive weight gain in the first trimester can be a sign of potential issues that need monitoring and intervention to ensure the well-being of both the mother and the baby. Choices A, C, and D represent weight gains that are within normal ranges for the respective trimesters and do not raise immediate concerns for reporting to the provider.

4. A client is scheduled for a maternal serum alpha-fetoprotein test at 15 weeks of gestation. The client asks the nurse about the purpose of this test. What explanation should the nurse provide?

• A. This test screens for neural tube defects and other developmental abnormalities in the fetus.
• B. It assesses various markers of fetal well-being.
• C. This test identifies an Rh incompatibility between the mother and fetus.
• D. It is a screening test for spinal defects in the fetus.

Correct answer: A

Rationale: The maternal serum alpha-fetoprotein (MSAFP) test is performed around 15-18 weeks of gestation to screen for neural tube defects and other developmental abnormalities in the fetus, not to assess fetal lung maturity, markers of fetal well-being, or Rh incompatibility between the mother and fetus. Choice A is the correct answer as it accurately reflects the purpose of the MSAFP test. Choices B, C, and D are incorrect because they do not align with the primary goal of this screening test.

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.

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