Nursing Elites

1. The nurse is receiving a report for a laboring client who arrived in the emergency center with ruptured membranes that the client did not recognize. Which is the priority nursing action to implement when the client is admitted to the labor and delivery suite?

• A. Begin a pad count
• B. Prepare to start an IV
• C. Take the client's temperature
• D. Monitor amniotic fluid for meconium

Correct answer: C

Rationale: The priority nursing action when a client with ruptured membranes is admitted to the labor and delivery suite is to take the client's temperature. This is crucial to assess for infection, especially when the duration of membrane rupture is unknown. Beginning a pad count, preparing to start an IV, and monitoring amniotic fluid for meconium are important actions but are not as immediate or critical as assessing for infection through temperature measurement.

2. Do sebaceous glands cause a developing organism to grow arms or wings, skin, or scales?

• A. True
• B. False
• C. Possibly
• D. Never

Correct answer: B

Rationale: The correct answer is B: False. Sebaceous glands are associated with the skin's oil production and have no role in the development of limbs or body coverings. Sebaceous glands primarily produce sebum, an oily substance that lubricates and waterproofs the skin and hair. Choices A, C, and D are incorrect because sebaceous glands do not influence the growth of arms, wings, skin, or scales in a developing organism.

3. A newborn assessment reveals spina bifida occulta. Which maternal factor should the nurse identify as having the greatest impact on the development of this newborn complication?

• A. Tobacco use.
• B. Folic acid deficiency.
• C. Short interval between pregnancies.
• D. Preeclampsia.

Correct answer: B

Rationale: Folic acid deficiency during pregnancy is strongly associated with neural tube defects like spina bifida occulta. Adequate folic acid intake before and during early pregnancy significantly reduces the risk of such complications. Tobacco use (Choice A) is linked to other adverse outcomes but not specifically spina bifida occulta. Short intervals between pregnancies (Choice C) can increase the risk of preterm birth and low birth weight but are not directly linked to spina bifida occulta. Preeclampsia (Choice D) is a hypertensive disorder that poses risks to both the mother and baby but is not the primary factor contributing to spina bifida occulta development.

4. Which of the following statements is true of Down’s syndrome?

• A. Down’s syndrome is usually caused by an extra copy of chromosome 21 in an individual.
• B. The symptoms of Down’s syndrome are similar to those of sickle-cell anemia.
• C. Down’s syndrome is caused by a sexually transmitted infection (STI) during conception.
• D. The probability of having a child with Down’s syndrome increases with the age of the parents.

Correct answer: D

Rationale: The correct answer is D. The likelihood of having a child with Down’s syndrome increases as the age of the parents increases, particularly the mother's age. Choice A is incorrect because Down’s syndrome is caused by an extra copy of chromosome 21, not a defect in the sex chromosomes. Choice B is incorrect as the symptoms of Down’s syndrome and sickle-cell anemia are different. Choice C is also incorrect as Down’s syndrome is not caused by a sexually transmitted infection during conception.

5. A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?

• A. “Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.”
• B. “The drug keeps your baby from requiring too much sedation.”
• C. “Surfactant is used to reduce episodes of periodic apnea.”
• D. “Your baby needs this medication to fight a possible respiratory tract infection.”

Correct answer: A

Rationale: Artificial surfactant can be administered as an adjunct to oxygen and ventilation therapy for premature infants with respiratory distress syndrome (RDS). It helps improve respiratory compliance by aiding in the exchange of oxygen and carbon dioxide until the infant can produce enough surfactant naturally. The correct explanation to the parents would be that surfactant therapy enhances the baby’s lung function by facilitating the exchange of oxygen and carbon dioxide. Choice B is incorrect because surfactant therapy does not affect sedation needs. Choice C is inaccurate as surfactant is not used to reduce episodes of periodic apnea. Choice D is incorrect as surfactant is not administered to fight respiratory tract infections; it specifically targets improving lung function in RDS.

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