Nursing Elites

1. In planning care for a client at 30-weeks gestation experiencing preterm labor, what maternal prescription is most important in preventing this fetus from developing respiratory syndrome?

• A. Betamethasone (Celestone) 12mg deep IM.
• B. Butorphanol 1mg IV push q2h PRN pain.
• C. Ampicillin 1g IV push q8h.
• D. Terbutaline (Brethine) 0.25mg subcutaneously q15 minutes x3.

Correct answer: A

Rationale: The administration of Betamethasone (Celestone) is crucial in cases of preterm labor to promote fetal lung maturation and reduce the risk of respiratory distress syndrome in the newborn. Betamethasone helps enhance the production of surfactant in the fetal lungs, improving their functionality and decreasing the likelihood of respiratory complications upon birth. Butorphanol is an analgesic and not indicated for preventing respiratory syndrome in preterm infants. Ampicillin is an antibiotic used for infection prevention and treatment, not for fetal lung maturation. Terbutaline is a tocolytic agent used to inhibit contractions, but it does not have a direct effect on fetal lung maturity.

2. A mother calls the school nurse to report that her preschool-aged child was bitten by a tick during a school outing last week. The mother removed the tick and flushed it down the toilet. What action should the school nurse take?

• A. Refer the mother to the Centers for Disease Control and Prevention.
• B. Report the incident to the school principal.
• C. Culture the bite site when the child returns to school.
• D. Schedule a test for Lyme disease if a rash appears.

Correct answer: D

Rationale: The correct action to take in this situation is to schedule a test for Lyme disease if a rash appears. Lyme disease can be transmitted through tick bites, and a rash is a common early symptom of the disease. Testing for Lyme disease is crucial for timely diagnosis and treatment to prevent complications. Referring the mother to the Centers for Disease Control and Prevention (Choice A) is not necessary at this point, as immediate testing for Lyme disease is more appropriate. Reporting the incident to the school principal (Choice B) is not the most direct action to address the potential health concern. Culturing the bite site when the child returns to school (Choice C) may not be as effective as scheduling a test for Lyme disease if a rash appears, as the latter is a more specific diagnostic measure for Lyme disease.

3. The LPN/LVN assesses a client admitted to the labor and delivery unit and obtains the following data: dark red vaginal bleeding, uterus slightly tense between contractions, BP 110/68, FHR 110 beats/minute, cervix 1 cm dilated and uneffaced. Based on these assessment findings, what intervention should the nurse implement?

• A. Insert an internal fetal monitor.
• B. Assess for cervical changes q1h.
• C. Monitor bleeding from IV sites.
• D. Perform Leopold's maneuvers.

Correct answer: C

Rationale: Monitoring for bleeding from IV sites is the priority intervention in this situation. The dark red vaginal bleeding, uterine tension, and other assessment findings suggest a potential placental abruption. Monitoring bleeding from IV sites can help detect coagulopathy, which may be associated with placental abruption. Options A, B, and D are not the most appropriate interventions in this scenario. Inserting an internal fetal monitor, assessing for cervical changes, and performing Leopold's maneuvers are not the priority actions when dark red vaginal bleeding and uterine tension are present, indicating a potential emergency situation.

4. During a prenatal visit, the nurse discusses with a client the effects of smoking on the fetus. When compared with nonsmokers, mothers who smoke during pregnancy tend to produce infants who have

• A. lower Apgar scores.
• B. lower birth weights.
• C. respiratory distress.
• D. a higher rate of congenital anomalies.

Correct answer: B

Rationale: Smoking during pregnancy is associated with intrauterine growth restriction, leading to lower birth weights. This occurs due to the harmful effects of smoking on fetal development, which can result in reduced nutrient and oxygen supply to the fetus, impacting its overall growth and leading to lower birth weights. Choices A, C, and D are incorrect as smoking during pregnancy primarily affects fetal growth and development, leading to lower birth weights rather than lower Apgar scores, respiratory distress, or a higher rate of congenital anomalies.

5. A child with leukemia is admitted for chemotherapy, and the nursing diagnosis 'altered nutrition, less than body requirements related to anorexia, nausea, and vomiting' is identified. Which intervention should the nurse include in this child’s plan of care?

• A. Allow the child to eat any food desired and tolerated.
• B. Provide small, frequent meals that are high in protein and calories.
• C. Offer the child preferred foods and avoid foods that are not well-tolerated.
• D. Consult with a dietitian to provide appropriate nutritional support.

Correct answer: B

Rationale: In children with leukemia undergoing chemotherapy, anorexia, nausea, and vomiting are common issues leading to altered nutrition. Providing small, frequent meals that are high in protein and calories is essential to address these symptoms and meet the child's nutritional needs effectively. This approach helps in managing the side effects of treatment and supporting the child's nutritional requirements during this challenging time.

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