Nursing Elites

1. A client is experiencing sore nipples from breastfeeding. Which of the following actions should the nurse take?

• A. Place a snug dressing on the client’s nipple when not breastfeeding
• B. Ensure the newborn’s mouth is wide open before latching to the breast
• C. Encourage the client to limit the newborn’s feeding to 10 minutes on each breast
• D. Instruct the client to begin the feeding with the nipple that is most tender

Correct answer: B

Rationale: Ensuring the newborn's mouth is wide open before latching is crucial for achieving a proper latch, which can help reduce nipple soreness. Placing a snug dressing on the nipple when not breastfeeding (choice A) can lead to further irritation and hinder healing. Encouraging the client to limit the newborn’s feeding to 10 minutes on each breast (choice C) may not be adequate for effective feeding as infants should feed until they are satisfied. Instructing the client to begin feeding with the most tender nipple (choice D) can worsen the soreness as it may not allow the baby to feed effectively.

2. A newborn is 24 hours old, and a healthcare provider is caring for them. Which of the following laboratory findings should the healthcare provider report to the provider?

• A. Hgb 20 g/dL
• B. Bilirubin 2 mg/dL
• C. Platelets 200,000/mm3
• D. WBC count 32,000/mm3

Correct answer: D

Rationale: The correct answer is D: WBC count 32,000/mm3. A WBC count of 32,000/mm3 is significantly elevated in a newborn and could indicate an infection, which needs immediate attention and intervention. High white blood cell counts in newborns can be concerning as they may suggest an ongoing infection or other underlying issues that require prompt medical evaluation and treatment. Choices A, B, and C are within normal ranges for a newborn and would not typically warrant immediate reporting to the provider. Hgb levels of 20 g/dL (Choice A) are high for newborns, but this is not as concerning as a significantly elevated WBC count. Bilirubin levels of 2 mg/dL (Choice B) are within normal limits for a newborn and do not indicate immediate issues. Platelet count of 200,000/mm3 (Choice C) is also within the normal range for a newborn and would not require immediate reporting.

3. According to a study in 2013 by van Gameren-Oosterom, individuals with Down syndrome:

• A. are unlikely to die from cardiovascular problems by middle age.
• B. have no specific characteristic features.
• C. show deficits in cognitive development.
• D. are likely to have only 46 chromosomes.

Correct answer: C

Rationale: The correct answer is C. According to a study in 2013 by van Gameren-Oosterom, individuals with Down syndrome often exhibit deficits in cognitive development. This is a common characteristic of Down syndrome, along with other health challenges. Choice A is incorrect because individuals with Down syndrome are at a higher risk of cardiovascular problems, contrary to being unlikely to die from them. Choice B is incorrect as Down syndrome is associated with specific characteristic features such as distinctive facial characteristics, making the statement that they have no specific features incorrect. Choice D is incorrect as individuals with Down syndrome have an extra copy of chromosome 21, resulting in a total of 47 chromosomes, not 46.

4. A 30-year-old primigravida delivers a nine-pound (4082 gram) infant vaginally after a 30-hour labor. What is the priority nursing action for this client?

• A. Assess the blood pressure for hypertension.
• B. Gently massage fundus every four hours.
• C. Observe for signs of uterine hemorrhage.
• D. Encourage direct contact with the infant.

Correct answer: C

Rationale: After a prolonged labor and delivery of a large infant, the client is at an increased risk for uterine atony and postpartum hemorrhage, making observation for signs of bleeding a priority. Assessing the blood pressure for hypertension (Choice A) is not the priority in this situation as the immediate concern is postpartum hemorrhage. Gently massaging the fundus every four hours (Choice B) is a routine postpartum care activity but is not the priority in this scenario. Encouraging direct contact with the infant (Choice D) is important for bonding but does not address the immediate risk of uterine hemorrhage after delivery.

5. A client with preeclampsia is receiving magnesium sulfate by continuous IV infusion. Which finding should the nurse report to the provider?

• A. Blood pressure 148/94 mm Hg
• B. Respiratory rate 14/min
• C. Urinary output 20 mL/hr
• D. 2+ deep tendon reflexes

Correct answer: C

Rationale: In a client with preeclampsia receiving magnesium sulfate, a urinary output of 20 mL/hr is a concerning finding as it may indicate renal impairment or magnesium toxicity. Adequate urinary output is crucial for eliminating excess magnesium and preventing toxicity. The nurse should report this finding to the provider for further evaluation. A blood pressure of 148/94 mm Hg is elevated but expected in a client with preeclampsia. A respiratory rate of 14/min is within the normal range. 2+ deep tendon reflexes are a common finding in clients receiving magnesium sulfate and are not a cause for concern unless they progress to hyperreflexia or clonus.

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