Nursing Elites

1. When caring for a pregnant woman with cardiac problems, the nurse must be alert for the signs and symptoms of cardiac decompensation. Which critical findings would the nurse find on assessment of the client experiencing this condition?

• A. Regular heart rate and hypertension.
• B. Increased urinary output, tachycardia, and dry cough.
• C. Shortness of breath, bradycardia, and hypertension.
• D. Dyspnea, crackles, and an irregular, weak pulse.

Correct answer: D

Rationale: In pregnant women with cardiac problems, signs of cardiac decompensation include dyspnea, crackles, an irregular, weak, and rapid pulse, rapid respirations, a moist and frequent cough, generalized edema, increasing fatigue, and cyanosis of the lips and nailbeds. Choice A is incorrect as a regular heart rate and hypertension are not typically associated with cardiac decompensation. Choice B is incorrect as increased urinary output and dry cough are not indicative of cardiac decompensation, only tachycardia is. Choice C is incorrect as bradycardia and hypertension are not typically seen in cardiac decompensation; dyspnea is a critical sign instead.

2. A newborn's head circumference is 12 inches (30.5 cm) and his chest measurement is 13 inches (33 cm). The nurse notes that this infant has no molding, and it was a breech presentation delivered by cesarean section. What action should the nurse take based on this data?

• A. No action needs to be taken, it is normal for an infant born by cesarean section to have a small head circumference.
• B. Notify the pediatrician immediately. These signs support the possibility of hydrocephalus.
• C. Call these findings to the attention of the pediatrician. The head/chest ratio is abnormal.
• D. Record the findings on the chart. They are within normal limits.

Correct answer: D

Rationale: Head and chest circumference measurements are within normal limits for a newborn, especially for those delivered by cesarean section, so no immediate action is required beyond documentation.

3. A newborn is scheduled to start phototherapy using a lamp. Which of the following actions should the nurse include in the plan?

• A. Apply a thin layer of lotion to the newborn's skin every 8 hours.
• B. Give the newborn 1 oz of glucose water every 4 hours.
• C. Ensure the newborn's eyes are closed beneath the shield.
• D. Dress the newborn in a thin layer of clothing during therapy.

Correct answer: C

Rationale: During phototherapy using a lamp, it is crucial to protect the newborn's eyes from the light to prevent damage. Closing the newborn's eyes beneath the shield is essential for this purpose. Applying lotion to the skin (Choice A) is not recommended as it can intensify the effects of the phototherapy. Giving glucose water (Choice B) is unrelated to the phototherapy process and is not indicated. Dressing the newborn in clothing (Choice D) may hinder the effectiveness of the phototherapy by blocking the light exposure to the skin.

4. Polygenic traits are those that are:

• A. developed during adolescence.
• B. transmitted by the mother.
• C. uncommon in humans.
• D. determined by several pairs of genes.

Correct answer: D

Rationale: Polygenic traits, such as height and skin color, are determined by several pairs of genes working together. These traits are influenced by the combined effects of multiple genes across the genome, rather than being controlled by a single gene pair. Choices A, B, and C are incorrect because polygenic traits are not specifically developed during adolescence, transmitted by the mother, or uncommon in humans. Understanding polygenic traits is essential in genetics as they demonstrate the complexity of genetic inheritance and the influence of multiple genes on a single trait.

5. A woman with gestational diabetes has had little or no experience reading and interpreting glucose levels. The client shows the nurse her readings for the past few days. Which reading signals the nurse that the client may require an adjustment of insulin or carbohydrates?

• A. 75 mg/dl before lunch. This is low; better eat now.
• B. 115 mg/dl 1 hour after lunch. This is a little high; maybe eat a little less next time.
• C. 115 mg/dl 2 hours after lunch. This is too high; it is time for insulin.
• D. 50 mg/dl just after waking up from a nap. This is too low; maybe eat a snack before going to sleep.

Correct answer: D

Rationale: 50 mg/dl after waking from a nap is too low. During hours of sleep, glucose levels should not be less than 60 mg/dl. Snacks before sleeping can be helpful. The premeal acceptable range is 60 to 99 mg/dl. The readings 1 hour after a meal should be less than 129 mg/dl. Two hours after eating, the readings should be less than 120 mg/dl.

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