Nursing Elites

1. The healthcare provider is assessing a postpartum client who is 1 day post-delivery. Which finding would require immediate intervention?

• A. Lochia rubra with a few small clots
• B. Fundus firm and midline
• C. Temperature of 100.4°F (38°C)
• D. Saturated perineal pad in 15 minutes

Correct answer: D

Rationale: A saturated perineal pad in 15 minutes indicates excessive bleeding, known as postpartum hemorrhage, which is a critical condition requiring immediate intervention to prevent further complications like hypovolemic shock. Monitoring and managing postpartum bleeding are crucial in the early postpartum period to ensure the client's safety and well-being. The other options are normal postpartum findings: lochia rubra with a few small clots is expected in the early postpartum period, a firm and midline fundus indicates proper uterine contraction, and a temperature of 100.4°F (38°C) is within the normal range for the postpartum period.

2. Which of the following is NOT an appropriate treatment for an 18-year-old woman with severe vaginal bleeding?

• A. Covering the vagina with a trauma dressing.
• B. Administering high concentrations of oxygen.
• C. Placing sterile dressings into the vagina.
• D. Keeping her warm with blankets.

Correct answer: C

Rationale: Placing sterile dressings into the vagina is not an appropriate treatment for severe vaginal bleeding. The correct approach involves applying pressure to the external vaginal area to control bleeding, covering the vagina with a trauma dressing to help with compression, administering high concentrations of oxygen to support oxygenation, and keeping the patient warm with blankets to prevent hypothermia. Placing sterile dressings into the vagina can introduce foreign material, increase the risk of infection, and obstruct proper wound management, making it an incorrect treatment option in this scenario.

3. When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?

• A. Avoid hyperventilation and ensure adequate chest rise.
• B. Squeeze the bag with both hands and use a pediatric mask.
• C. Immediately insert an oropharyngeal airway.
• D. Provide one breath every 3 to 5 seconds.

Correct answer: A

Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.

4. You are dispatched to a residence for a child with respiratory distress. The child is wheezing and has nasal flaring and retractions. His oxygen saturation is 92%. You should:

• A. place the child in a supine position.
• B. administer high-flow oxygen.
• C. begin chest compressions.
• D. administer low-flow oxygen.

Correct answer: B

Rationale: In a scenario where a child presents with respiratory distress, wheezing, nasal flaring, retractions, and an oxygen saturation of 92%, the appropriate intervention is to administer high-flow oxygen. This helps to improve oxygenation and alleviate the respiratory distress the child is experiencing. Placing the child in a supine position can worsen their condition by affecting their ability to breathe effectively. Chest compressions are not indicated in this case as the child is not in cardiac arrest. Administering low-flow oxygen may not provide adequate oxygenation for a child in respiratory distress with a saturation of 92%. Therefore, the priority is to administer high-flow oxygen to improve oxygen levels and support the child's breathing.

5. After providing home care instructions to the mother of a child being discharged following cardiac surgery, which statement made by the mother indicates a need for further instructions?

• A. A balance of rest and exercise is important.
• B. I can apply lotion or powder to the incision if it is itchy.
• C. Activities in which falling could occur need to be avoided for two to four weeks.
• D. Large crowds of people need to be avoided for at least two weeks after the surgery.

Correct answer: B

Rationale: The correct answer is B. The mother stating that she can apply lotion or powder to the incision if it is itchy indicates a need for further instructions. Applying lotion or powder to the incision is not recommended as it can increase the risk of infection. The other choices are correct: A) Balancing rest and exercise is important for recovery, C) avoiding activities where falling could occur is necessary to prevent injury, and D) avoiding large crowds helps reduce the risk of infections during the initial recovery period.

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