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 newborn is small for gestational age (SGA). Which of the following findings is associated with this condition?

• A. Moist skin
• B. Protruding abdomen
• C. Gray umbilical cord
• D. Wide skull sutures

Correct answer: D

Rationale: Wide skull sutures are a common finding in newborns who are small for gestational age (SGA) due to reduced intrauterine growth. This occurs because the skull bones do not grow at the same rate as the brain, leading to wider sutures. Moist skin, a protruding abdomen, and a gray umbilical cord are not typically associated with being small for gestational age.

3. A client who is 2 days postpartum reports that their 4-year-old son, who was previously toilet trained, is now wetting himself frequently. Which of the following statements should the nurse provide to the client?

• A. Your son may not have been ready for toilet training and should wear training pants.
• B. Your son is displaying an adverse sibling response.
• C. Your son may benefit from counseling.
• D. Consider enrolling your son in preschool to address the behavior.

Correct answer: B

Rationale: The regression in toilet training is a common adverse sibling response to the birth of a new baby. When a new sibling arrives, the older child may revert to behaviors from an earlier stage, such as bedwetting, to gain attention or cope with feelings of insecurity. This behavior is temporary and often resolves with time and reassurance. Recommending counseling or preschool at this point would be premature and not addressing the underlying cause of the behavior.

4. A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, 'I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device.' The nurse should suspect which of the following?

• A. Missed abortion
• B. Ectopic pregnancy
• C. Severe preeclampsia
• D. Hydatidiform mole

Correct answer: B

Rationale: Ectopic pregnancy should be suspected in clients with abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding, especially if they have an intrauterine device (IUD). In this case, the client's symptoms are classic for ectopic pregnancy, where the fertilized egg implants outside the uterus, commonly in the fallopian tube. Missed abortion (choice A) refers to a nonviable embryo or fetus in the uterus, which is not consistent with the client's presentation. Severe preeclampsia (choice C) is characterized by hypertension and proteinuria, not the symptoms described. Hydatidiform mole (choice D) presents with vaginal bleeding but typically lacks abdominal pain and is not related to the presence of an IUD.

5. During Leopold maneuvers on a client in labor, which technique should be used by the nurse to identify the fetal lie?

• A. Apply palms of both hands to sides of the uterus
• B. Palpate the fundus of the uterus
• C. Grasp the lower uterine segment between thumb and fingers
• D. Stand facing the client's feet with fingertips outlining cephalic prominence

Correct answer: B

Rationale: Palpating the fundus of the uterus during Leopold maneuvers is crucial to identify the fetal lie. This technique allows the nurse to determine the position of the baby's back and locate the fetal heart sounds, aiding in assessing the fetal lie. Choices A, C, and D are incorrect as they do not directly relate to identifying the fetal lie during Leopold maneuvers. Applying palms to the sides of the uterus or grasping the lower uterine segment do not provide the necessary information about the fetal lie. Standing facing the client's feet and outlining cephalic prominence is more related to assessing the fetal presentation, not the fetal lie.

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