Nursing Elites

1. What advice is most important for a client in the first trimester of pregnancy experiencing nausea?

• A. Practice relaxation techniques when nausea begins.
• B. Increase fluid intake to 3 quarts daily.
• C. Avoid alcohol, caffeine, and smoking.
• D. Eliminate snacks between meals.

Correct answer: C

Rationale: During the first trimester of pregnancy, it is crucial to advise pregnant clients to avoid alcohol, caffeine, and smoking. These substances can worsen nausea and harm fetal development. By eliminating these substances, the client can help alleviate nausea and create a healthier environment for the developing fetus. Choices A, B, and D are not as critical in managing nausea during the first trimester. While relaxation techniques may help, avoiding harmful substances like alcohol, caffeine, and smoking takes precedence. Increasing fluid intake can be beneficial but not as crucial as avoiding harmful substances. Eliminating snacks between meals may not be necessary for all clients and is not directly related to managing nausea in the first trimester.

2. A 34-week primigravida woman with preeclampsia is receiving Lactated Ringer’s 500ml with magnesium sulfate 20 grams at the rate of 3g/hr. How many ml/hr should the nurse program the infusion pump?

• A. 75ml/hr
• B. 100ml/hr
• C. 50ml/hr
• D. 25ml/hr

Correct answer: A

Rationale: To calculate the infusion rate, divide the total quantity to be infused (500ml) by the total time (1 hour) which equals 500ml/hr. Since the magnesium sulfate is being given at 3g/hr, and 1g of magnesium sulfate is in 5ml of solution, the rate will be 3g/hr x 5ml/g = 15ml/hr. Therefore, the total infusion rate should be 500ml/hr + 15ml/hr = 515ml/hr. Hence, the nurse should program the infusion pump to deliver 75ml/hr (515ml/hr total - 500ml/hr Lactated Ringer's rate). This choice is correct because it accounts for both the Lactated Ringer's and magnesium sulfate rates. Choice B, 100ml/hr, is incorrect as it does not consider the additional magnesium sulfate infusion rate. Choice C, 50ml/hr, is incorrect because it does not account for the magnesium sulfate infusion. Choice D, 25ml/hr, is incorrect as it is too low and does not consider the magnesium sulfate being infused concurrently.

3. How can a nurse make a blind 8-year-old girl admitted to the hospital more comfortable?

• A. Bring familiar toys from home, such as a bear or doll.
• B. Explain the surroundings to the child.
• C. Allow the child to explore the room.
• D. Provide audio books and music.

Correct answer: A

Rationale: The correct answer is to bring familiar toys from home, such as a bear or doll. This action provides comfort and a sense of security for the child, as it allows her to have familiar objects around her in an unfamiliar environment, which can help reduce anxiety and stress during her hospital stay.

4. A two-year-old child with heart failure (HF) is admitted for replacement of a graft for coarctation of the aorta. Prior to administering the next dose of digoxin (Lanoxin), the nurse obtains an apical heart rate of 128 bpm. What action should the nurse take?

• A. Determine the pulse deficit
• B. Administer the scheduled dose
• C. Calculate the safe dose range
• D. Review the serum digoxin level

Correct answer: B

Rationale: The correct action for the nurse to take is to administer the scheduled dose of digoxin. A heart rate of 128 bpm in a two-year-old child with heart failure falls within the safe range for digoxin administration. It indicates that the child's heart rate is not excessively low, which could be a concern for administering digoxin. Therefore, proceeding with the scheduled dose is appropriate in this scenario. Determining the pulse deficit (Choice A) is not necessary in this situation as the heart rate is already obtained. Calculating the safe dose range (Choice C) is not required as the heart rate is within the safe range. Reviewing the serum digoxin level (Choice D) is not needed at this point since the heart rate indicates that administering the next dose is appropriate.

5. When preparing a class on newborn care for expectant parents, what content should be taught concerning the newborn infant born at term gestation?

• A. Milia are white marks caused by sebaceous glands and typically resolve within 2 to 4 weeks.
• B. Meconium is the first stool and is typically dark green or black in color.
• C. Vernix caseosa is a white, cheesy substance mainly found in skin folds, providing a protective layer.
• D. Pseudostrabismus in newborns usually self-resolves without the need for intervention.

Correct answer: C

Rationale: Vernix caseosa is a white, cheesy substance that acts as a protective barrier on the skin of newborns, particularly present in skin folds. It helps to prevent dehydration and protect the delicate skin of the newborn from the amniotic fluid in utero. Educating expectant parents about the presence and function of vernix caseosa can help them understand the importance of its preservation during the immediate postnatal period. Choices A, B, and D are incorrect as they do not directly relate to the protective function of vernix caseosa in newborns. Milia are small, white bumps on the skin due to blocked oil glands, meconium is the first stool of a newborn and is typically dark green or black in color, and pseudostrabismus refers to false appearance of misalignment of the eyes, which usually resolves on its own without intervention.

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