Nursing Elites

1. A 4-week-old premature infant has been receiving epoetin alfa (Epogen) for the last three weeks. Which assessment finding indicates to the healthcare provider that the drug is effective?

• A. Slowly increasing urinary output over the last week.
• B. Respiratory rate changes from the 40s to the 60s.
• C. Changes in apical heart rate from the 180s to the 140s.
• D. Change in indirect bilirubin from 12 mg/dl to 8 mg/dl.

Correct answer: C

Rationale: The correct answer is C. Epoetin alfa stimulates erythropoiesis, leading to an increase in red blood cell production and improving oxygen-carrying capacity. As the oxygenation status improves, there is a reduction in heart rate. Therefore, changes in apical heart rate from the 180s to the 140s indicate that the drug is effective. Choices A, B, and D are incorrect because they do not directly reflect the expected outcome of epoetin alfa therapy. Increasing urinary output, changes in respiratory rate, and decreasing bilirubin levels are not primary indicators of the drug's effectiveness in this context.

2. 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.

3. A client at 32 weeks gestation is hospitalized with severe pregnancy-induced hypertension (PIH), and magnesium sulfate is prescribed to control the symptoms. Which assessment finding indicates the therapeutic drug level has been achieved?

• A. 4+ reflexes
• B. Urinary output of 50 ml per hour
• C. A decrease in respiratory rate from 24 to 16
• D. A decreased body temperature

Correct answer: C

Rationale: A decrease in respiratory rate from 24 to 16 indicates that magnesium sulfate is effectively reducing central nervous system irritability, a desired therapeutic effect. This decrease in respiratory rate signifies that the drug has reached a therapeutic level to control symptoms of severe pregnancy-induced hypertension. Choices A, B, and D are incorrect because 4+ reflexes, urinary output, and body temperature are not direct indicators of achieving a therapeutic level of magnesium sulfate for controlling PIH symptoms.

4. While preparing a 10-year-old with a lacerated forehead for suturing, the nurse notices both parents and a 12-year-old sibling at the child’s bedside. Which instruction best supports the family's involvement?

• A. While waiting for the healthcare provider, only one visitor may stay with the child.
• B. All of you should leave while the healthcare provider sutures the child’s forehead.
• C. It is best if the sibling goes to the waiting room until the suturing is completed.
• D. Please decide who will stay when the healthcare provider begins suturing.

Correct answer: D

Rationale: Involving the family by letting them decide who will stay during the suturing process promotes family engagement and comfort, ensuring the presence of a familiar person for the child during the procedure.

5. A client is admitted to the postpartum unit and tells the nurse she had rheumatic fever as a child, which resulted in some 'heart damage'. The nurse knows that this client is at particular risk for developing heart failure during the immediate postpartum period. Based on the client's history, which nursing problem has the highest priority?

• A. Nausea and vomiting.
• B. Risk for infection.
• C. Sleep deprivation.
• D. Fluid volume excess.

Correct answer: D

Rationale: Fluid volume excess is a priority concern in this client, as heart damage from rheumatic fever can impair the heart's ability to manage increased blood volume postpartum, leading to potential heart failure. Monitoring and managing fluid volume status are crucial to prevent complications in this high-risk client. Choices A, B, and C are not the highest priority in this situation. Nausea and vomiting, risk for infection, and sleep deprivation are important but do not pose an immediate threat to the client's physiologic stability compared to the risk of heart failure due to fluid volume excess.

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