Nursing Elites

1. While caring for a newborn, a nurse auscultates an apical heart rate of 130/min. Which of the following actions should the nurse take?

• A. Ask another nurse to verify the heart rate.
• B. Document this as an expected finding.
• C. Call the provider to further assess the newborn.
• D. Prepare the newborn for transport to the NICU.

Correct answer: B

Rationale: An apical heart rate of 130/min is within the expected range for a newborn. It is not necessary to seek verification from another nurse, call the provider for further assessment, or prepare for NICU transport based on this heart rate. Documenting the heart rate as an expected finding is the appropriate action in this situation as it falls within the normal range for a newborn's heart rate.

2. A woman in a women's health clinic is receiving teaching about nutritional intake during her 8th week of gestation. The healthcare provider should advise the woman to increase her daily intake of which of the following nutrients?

• A. Calcium
• B. Vitamin E
• C. Iron
• D. Vitamin D

Correct answer: C

Rationale: During pregnancy, the recommended daily iron intake is higher compared to non-pregnant women. Pregnant women should aim for 27 mg/day of iron, while non-pregnant women require 15 mg/day if under 19 years old and 18 mg/day if between 19 and 50 years old. Iron is essential during pregnancy to support the increased blood volume and ensure the proper oxygen supply to the fetus. Calcium is important for bone health but does not need a significant increase during early pregnancy. Vitamin E and Vitamin D are important but do not have specific increases recommended during the 8th week of gestation.

3. A client is being discharged after childbirth. At 4 weeks postpartum, the client should contact the provider for which of the following client findings?

• A. Scant, non-odorous white vaginal discharge
• B. Uterine cramping during breastfeeding
• C. Sore nipple with cracks and fissures
• D. Decreased response with sexual activity

Correct answer: C

Rationale: Sore nipples with cracks and fissures should be reported to the provider as this can indicate improper breastfeeding techniques or infection, which requires medical evaluation and intervention to prevent further complications such as mastitis or decreased milk supply. Scant, non-odorous white vaginal discharge is a normal finding postpartum. Uterine cramping during breastfeeding is also common due to oxytocin release. Decreased response with sexual activity may be expected at 4 weeks postpartum due to hormonal changes and fatigue, but it is not typically a concern that needs immediate medical attention.

4. A healthcare professional is preparing to administer magnesium sulfate 2 g/hr IV to a client who is in preterm labor. Available is 20 g of magnesium sulfate in 500 mL of dextrose 5% in water (D5W). How many mL/hr should the IV infusion pump be set to administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

• A. 60
• B. 30
• C. 50
• D. 80

Correct answer: C

Rationale: To administer magnesium sulfate 2 g/hr IV, the healthcare professional should set the IV infusion pump to administer 50 mL/hr. The calculation is as follows: 20 g / 500 mL = 2 g / X mL, X = 50 mL/hr. Choice A (60 mL/hr) is incorrect as it does not match the calculated rate. Choice B (30 mL/hr) is incorrect as it is half of the calculated rate. Choice D (80 mL/hr) is incorrect as it is higher than the calculated rate.

5. 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.

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