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 client at 36 weeks of gestation is suspected of having placenta previa. Which of the following findings support this diagnosis?

• A. Painless red vaginal bleeding
• B. Increasing abdominal pain with a non-relaxed uterus
• C. Abdominal pain with scant red vaginal bleeding
• D. Intermittent abdominal pain following the passage of bloody mucus

Correct answer: A

Rationale: Painless red vaginal bleeding is a hallmark sign of placenta previa. In this condition, the placenta partially or completely covers the cervical opening, leading to painless, bright red bleeding due to the separation of the placenta from the uterine wall. Other types of bleeding, such as those associated with abdominal pain or mucus passage, are more indicative of conditions like placental abruption rather than placenta previa. Therefore, choices B, C, and D are incorrect as they describe findings more consistent with placental abruption rather than placenta previa.

3. A client in active labor at 39 weeks of gestation is receiving continuous IV oxytocin and has early decelerations in the FHR on the monitor tracing. What action should the nurse take?

• A. Discontinue the oxytocin infusion.
• B. Continue monitoring the client.
• C. Request that the provider assess the client.
• D. Increase the infusion rate of the maintenance IV fluid.

Correct answer: B

Rationale: Early decelerations in the FHR are benign and are typically caused by fetal head compression during contractions. In this case, with the client at 39 weeks of gestation and on oxytocin, it is important for the nurse to continue monitoring the client. Early decelerations do not require intervention as they are a normal response to certain stimuli and do not indicate fetal distress. Discontinuing the oxytocin infusion (Choice A) is not necessary as early decelerations are not related to oxytocin administration. Requesting the provider to assess the client (Choice C) is not needed for early decelerations as they are a normal finding. Increasing the infusion rate of the maintenance IV fluid (Choice D) is not indicated and would not address the early decelerations. Therefore, the appropriate action is to continue monitoring the client and reassess as needed.

4. A client is being educated by a healthcare provider about the physiological changes that occur during pregnancy. The client is at 10 weeks of gestation and has a BMI within the expected reference range. Which of the following client statements indicates an understanding of the teaching?

• A. I should gain more than 15 to 20 pounds during my pregnancy.
• B. I will likely need to use alternative positions for sexual intercourse.
• C. I'm glad I had a breast reduction years ago so they will not enlarge with my pregnancy.
• D. I'm glad I have a light complexion and will not get any stretch marks.

Correct answer: B

Rationale: During pregnancy, weight gain is expected. The client's understanding is demonstrated by acknowledging the need for alternative sexual positions due to the physiological changes, such as weight gain and a growing abdomen. This statement reflects comprehension of the teaching provided by the healthcare provider.

5. A healthcare professional is discussing risk factors for urinary tract infections with a newly licensed nurse. Which of the following conditions should the healthcare professional include in the teaching? (Select all that apply)

• A. Epidural anesthesia
• B. Urinary bladder catheterization
• C. Frequent pelvic examinations
• D. All of the Above

Correct answer: D

Rationale: Urinary tract infections can be influenced by various factors. Epidural anesthesia, urinary bladder catheterization, and frequent pelvic examinations are all associated with an increased risk of UTIs. Epidural anesthesia can introduce bacteria into the urinary tract, urinary bladder catheterization can serve as a pathway for bacteria to enter the bladder, and frequent pelvic examinations can disrupt the natural flora and introduce bacteria. Therefore, it is crucial for healthcare professionals to be aware of these risk factors to help prevent and manage UTIs effectively. Choice D, 'All of the Above,' is the correct answer as all the listed conditions are significant risk factors for urinary tract infections. Choices A, B, and C are incorrect because each of them, when present, can contribute to the development of UTIs. It is essential for healthcare professionals to educate patients and colleagues about these risk factors to minimize the occurrence of UTIs.

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