Nursing Elites

1. When caring for a newborn with macrosomia born to a mother with diabetes mellitus, which newborn complication should the nurse prioritize care for?

• A. Hypoglycemia
• B. Hypomagnesemia
• C. Hyperbilirubinemia
• D. Hypocalcemia

Correct answer: A

Rationale: In newborns of diabetic mothers with macrosomia, hypoglycemia is the priority focus of care due to the risk of developing low blood sugar levels after birth. Infants born to diabetic mothers are at risk of hypoglycemia because they have been exposed to high glucose levels in utero and produce high levels of insulin. Hypoglycemia can lead to serious complications if not promptly identified and managed, making it crucial for nurses to closely monitor blood glucose levels and provide necessary interventions to prevent adverse outcomes.

2. A healthcare provider is preparing to administer an injection of Rho (D) immunoglobulin. The provider should understand that the purpose of this injection is to prevent which of the following newborn complications?

• A. Hydrops fetalis
• B. Hypobilirubinemia
• C. Biliary atresia
• D. Transient clotting difficulties

Correct answer: B

Rationale: Rho (D) immunoglobulin is given to Rh-negative individuals to prevent hemolytic disease of the newborn (HDN) caused by Rh incompatibility between the mother and the fetus. If an Rh-negative mother carries an Rh-positive fetus, there is a risk of sensitization during pregnancy or childbirth. Sensitization can lead to the production of antibodies that may attack Rh-positive red blood cells in future pregnancies, potentially causing severe hemolytic disease in the newborn, including complications like hydrops fetalis. Hydrops fetalis is a condition characterized by severe edema and fetal organ enlargement due to severe anemia and heart failure in the fetus.

3. A client with chronic kidney disease has arterial blood gas values being reviewed by a nurse. Which of the following sets of values should the nurse expect?

• A. pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg
• B. pH 7.30, HCO3- 26 mEq/L, PaCO2 50 mm Hg
• C. pH 7.50, HCO3- 20 mEq/L, PaCO2 32 mm Hg
• D. pH 7.55, HCO3- 30 mEq/L, PaCO2 31 mm Hg

Correct answer: A

Rationale: In chronic kidney disease, metabolic acidosis is common due to impaired kidney function leading to reduced bicarbonate excretion. The correct values indicating metabolic acidosis in this scenario are a low pH (acidosis), low bicarbonate (HCO3-) level, and low PaCO2 (compensation through respiratory alkalosis). Therefore, the expected values for a client with chronic kidney disease would be pH 7.25, HCO3- 19 mEq/L, PaCO2 30 mm Hg, as depicted in choice A.

4. A nurse on the postpartum unit is caring for a group of clients with an assistive personnel (AP). Which of the following tasks should the nurse plan to delegate to the AP?

• A. Provide a sitz bath to a client who has a fourth-degree laceration and is 2 days postpartum.
• B. Observe an area of redness on the breast of a client who is 1 day postpartum.
• C. Monitor vital signs during admission of a client who has gestational hypertension.
• D. Change the perineal pad of a client who just transferred from labor and delivery.

Correct answer: A

Rationale: Delegating the task of providing a sitz bath to a client with a fourth-degree laceration and who is 2 days postpartum to the assistive personnel (AP) is appropriate. This task involves assisting the client with personal hygiene and comfort measures that can be safely performed by the AP under the supervision and direction of the nurse. Tasks like observing redness on the breast, monitoring vital signs during admission for gestational hypertension, and changing perineal pads may require a higher level of assessment and nursing judgment, making them more appropriate for the nurse to perform.

5. A woman at 38 weeks of gestation and in early labor with ruptured membranes has an oral temperature of 38.9�C (102�F). Besides notifying the provider, which of the following is an appropriate nursing action?

• A. Recheck the client's temperature in 4 hours
• B. Administer glucocorticoids intramuscularly
• C. Assess the odor of the amniotic fluid
• D. Prepare the client for emergency cesarean section

Correct answer: C

Rationale: In a pregnant woman with a temperature of 38.9�C (102�F) in early labor with ruptured membranes, assessing the odor of the amniotic fluid is crucial. Foul-smelling or malodorous amniotic fluid could indicate infection, such as chorioamnionitis, which poses risks to both the woman and the fetus. This assessment can help in determining if an infection is present and prompt appropriate interventions. Rechecking the temperature, administering glucocorticoids, or preparing for an emergency cesarean section are not the most immediate or appropriate actions in this scenario.

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