Nursing Elites

1. 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.

2. A charge nurse on the postpartum unit is observing a newly licensed nurse who is preparing to administer pain medication to a client. The charge nurse should intervene when the newly licensed nurse uses which of the following secondary identifiers to identify the client?

• A. The client's room number
• B. The client's telephone number
• C. The client's birth date
• D. The client's medical record number

Correct answer: A

Rationale: The correct answer is A. Using the client's room number as a secondary identifier is not an appropriate method for client identification in healthcare settings. It can lead to confusion and potential errors, especially in a busy environment like a postpartum unit. Room numbers are not unique to individual patients and can change frequently. Instead, healthcare providers should use more reliable and specific identifiers like the client's name, medical record number, or date of birth to ensure accurate identification and safe administration of medications. Choices B, C, and D are more appropriate secondary identifiers for client identification as they are more specific and less prone to errors than room numbers.

3. A client who is at 15 weeks of gestation, is Rh-negative, and has just had an amniocentesis. Which of the following interventions is the nurse's priority following the procedure?

• A. Check the client's temperature.
• B. Observe for uterine contractions.
• C. Administer Rho(D) immune globulin.
• D. Monitor the fetal heart rate (FHR).

Correct answer: D

Rationale: After an amniocentesis, the priority nursing intervention is to monitor the fetal heart rate (FHR) as the greatest risk to the client and fetus is fetal death. This monitoring helps in early identification of any fetal distress or compromise, allowing prompt intervention to ensure fetal well-being. Checking the client's temperature (Choice A) is not the priority as monitoring the fetus is crucial for immediate assessment. Observing for uterine contractions (Choice B) is important but not the priority after an amniocentesis. Administering Rho(D) immune globulin (Choice C) is typically done to Rh-negative clients after procedures that may lead to fetal-maternal hemorrhage, not immediately after an amniocentesis.

4. A healthcare provider is assessing a newborn who has a coarctation of the aorta. Which of the following should the provider recognize as a clinical manifestation of coarctation of the aorta?

• A. Increased blood pressure in the arms with decreased blood pressure in the legs
• B. Decreased blood pressure in the arms with increased blood pressure in the legs
• C. Increased blood pressure in both the arms and the legs
• D. Decreased blood pressure in both the arms and the legs

Correct answer: A

Rationale: The correct answer is increased blood pressure in the arms with decreased blood pressure in the legs. Coarctation of the aorta is a congenital heart defect characterized by a narrowing of the aorta, leading to increased blood pressure in the upper extremities and decreased blood pressure in the lower extremities due to decreased blood flow beyond the narrowing. Choice B is incorrect because coarctation of the aorta does not lead to increased blood pressure in the legs. Choice C is incorrect because increased blood pressure in both the arms and legs is not a typical manifestation of coarctation of the aorta. Choice D is incorrect because decreased blood pressure in both the arms and legs is not characteristic of coarctation of the aorta.

5. During an assessment, a client at 26 weeks of gestation presents with which of the following clinical manifestations that should be reported to the provider?

• A. Leukorrhea
• B. Supine hypotension
• C. Periodic numbness of the fingers
• D. Decreased urine output

Correct answer: D

Rationale: During pregnancy, decreased urine output can be indicative of decreased renal perfusion and impaired fetal well-being. It can also be a sign of preeclampsia when associated with symptoms like increased blood pressure, proteinuria, and decreased fetal activity. Therefore, the nurse should promptly report this finding to the healthcare provider for further evaluation and management. Leukorrhea is a common finding in pregnancy and not typically concerning. Supine hypotension and periodic numbness of the fingers can be managed by changing positions or adjusting posture and are not as urgent as decreased urine output in this context.

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