Nursing Elites

1. Warning signs that indicate dehydration include all EXCEPT:

• A. Poor skin turgor
• B. Increased urine output
• C. Tachycardia
• D. Eager to drink

Correct answer: B

Rationale: The correct answer is B. Increased urine output is not a warning sign of dehydration; it typically decreases with dehydration. Dehydration often presents with poor skin turgor, tachycardia, and an increased sensation of thirst (eager to drink) as the body tries to compensate for fluid loss. Choices A, C, and D are all correct warning signs of dehydration. Poor skin turgor is a result of decreased skin elasticity due to fluid loss. Tachycardia, an elevated heart rate, can be a compensatory mechanism to maintain cardiac output in dehydration. Feeling eager to drink is a common symptom of dehydration as the body attempts to restore fluid balance.

2. Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include:

• A. Clamping and cutting the umbilical cord.
• B. Gently pulling on the cord to facilitate removal.
• C. Trying to remove the cord from around the neck.
• D. Keeping the cord moist and providing rapid transport.

Correct answer: C

Rationale: When encountering a situation where the umbilical cord is wrapped around a baby's neck upon delivery, the initial treatment should involve trying to remove the cord from around the neck gently. It is crucial to handle this situation delicately to avoid causing harm to the baby. Attempting to ease the cord over the baby's head without pulling or tightening can help prevent potential complications associated with cord compression. Choice A, clamping and cutting the umbilical cord, is not recommended as it can lead to abrupt deprivation of oxygen to the baby. Choice B, gently pulling on the cord, can worsen the situation by tightening the cord around the baby's neck. Choice D, keeping the cord moist and providing rapid transport, is not the immediate concern and does not address the potential risks of cord compression during delivery. Therefore, the priority is to carefully attempt to remove the cord from around the baby's neck to ensure a safe delivery.

3. The healthcare provider is preparing to administer Rh immune globulin (RhoGAM) to a postpartum client. This medication is indicated for:

• A. Rh-negative individuals with Rh-positive infants
• B. Rh-positive individuals with Rh-negative infants
• C. All individuals regardless of Rh status
• D. Individuals with a history of Rh incompatibility

Correct answer: A

Rationale: Rh immune globulin (RhoGAM) is administered to Rh-negative individuals who have given birth to Rh-positive infants to prevent Rh sensitization. When an Rh-negative individual gives birth to an Rh-positive infant, there is a risk of the mother developing antibodies against the Rh-positive blood cells, which can lead to hemolytic disease of the newborn in subsequent pregnancies. Rh immune globulin is given to prevent this sensitization in Rh-negative individuals who deliver Rh-positive infants.

4. If a baby weighs 14 kg, how much fluid should be administered to the baby over 24 hours using a rate of 100 ml/kg?

• A. 1400ml
• B. 2600ml
• C. 1650ml
• D. 3360ml

Correct answer: A

Rationale: To calculate the fluid requirement for a baby, multiply the weight of the baby (14 kg) by the fluid rate (100 ml/kg): 14 kg x 100 ml/kg = 1400 ml. Therefore, the correct answer is 1400 ml.

5. Following the initial steps of resuscitation, a newborn remains apneic and cyanotic. What should you do next?

• A. begin ventilations with a bag-mask device.
• B. gently flick the soles of their feet for up to 60 seconds.
• C. immediately suction their mouth and nose.
• D. start CPR if the heart rate is less than 80 beats/min.

Correct answer: A

Rationale: If a newborn remains apneic and cyanotic after the initial resuscitation steps, the next appropriate action is to begin ventilations with a bag-mask device. This helps provide oxygen to the newborn and can be crucial in supporting their respiratory efforts. Option B of flicking the soles of their feet is not recommended in this scenario as the priority is addressing the respiratory distress. Option C of suctioning their mouth and nose is not the immediate next step if the newborn is not spontaneously breathing. Option D of starting CPR based only on the heart rate is not the first-line intervention for an apneic and cyanotic newborn.

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