Nursing Elites

1. What is the most critical physiologic change required of newborns at birth?

• A. Transition from fetal to neonatal breathing
• B. Body temperature maintenance
• C. Stabilization of fluid and electrolytes
• D. Closure of fetal shunts in the heart

Correct answer: A

Rationale: The correct answer is A: Transition from fetal to neonatal breathing. The onset of breathing is the most immediate and critical physiologic change required for the transition to extrauterine life. Factors that interfere with this normal transition increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis. While body temperature maintenance, stabilization of fluid and electrolytes, and closure of fetal shunts in the heart are crucial changes in the transition to extrauterine life, breathing and the exchange of oxygen for carbon dioxide must take precedence as they are essential for newborn survival.

2. What laboratory finding, in conjunction with the presenting symptoms, indicates minimal change nephrotic syndrome?

• A. Low specific gravity
• B. Decreased hemoglobin
• C. Normal platelet count
• D. Reduced serum albumin

Correct answer: D

Rationale: Reduced serum albumin is a hallmark of minimal change nephrotic syndrome (MCNS) due to massive proteinuria. This results in hypoalbuminemia, which contributes to the edema characteristic of this condition.

3. What tool would be most useful to assess maternal and newborn attachment behaviors?

• A. Apgar
• B. Ballard scale
• C. NCAST (Nursing Child Assessment Satellite Training) Feeding Scale
• D. Brazelton Neonatal Behavioral Assessment Scale

Correct answer: C

Rationale: The NCAST Feeding Scale is the most suitable tool to evaluate maternal and newborn attachment behaviors during feedings. It focuses on observing the interaction between the parent and infant, providing insights into their bonding. The Apgar score is used to assess a neonate's immediate transition to life outside the womb, not specifically maternal and newborn attachment behaviors. The Ballard scale is used to estimate gestational age, not to assess attachment behaviors. The Brazelton Neonatal Behavioral Assessment Scale is designed to evaluate a newborn's responses to various stimuli, not specifically maternal and newborn attachment behaviors.

4. Which laboratory test would be most important for the nurse to assess when caring for a toddler suspected of having cystic fibrosis?

• A. Liver enzymes
• B. Serum calcium
• C. Sweat chloride test
• D. Urine creatinine

Correct answer: C

Rationale: The sweat chloride test is the primary diagnostic test for cystic fibrosis. Cystic fibrosis is characterized by abnormal transport of chloride and sodium across epithelial cell membranes, leading to increased chloride in sweat. This test is crucial for diagnosing cystic fibrosis in suspected cases. Liver enzymes (Choice A), serum calcium (Choice B), and urine creatinine (Choice D) are not specific tests for cystic fibrosis and would not provide the necessary information for diagnosis in this case.

5. What disease should be suspected in a 3-day-old infant presenting with abdominal distention, vomiting, and failure to pass meconium?

• A. Pyloric stenosis
• B. Intussusception
• C. Hirschsprung disease
• D. Celiac disease

Correct answer: C

Rationale: Hirschsprung disease should be suspected in a newborn with abdominal distention, vomiting, and failure to pass meconium. This condition arises from a congenital absence of nerve cells in a portion of the colon, leading to severe constipation and intestinal obstruction. Pyloric stenosis typically presents with non-bilious projectile vomiting in the first few weeks of life. Intussusception classically manifests with sudden onset of colicky abdominal pain and currant jelly stools. Celiac disease may present with chronic diarrhea, failure to thrive, and abdominal distention but is less likely in this scenario.

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