Nursing Elites

1. When a family decides to withhold 'extraordinary care' for a newborn with severe abnormalities, what does this decision indicate?

• A. The newborn has no rights.
• B. It is the same as euthanasia.
• C. It is illegal professional practice.
• D. The newborn is being allowed to die.

Correct answer: D

Rationale: When a family decides to withhold 'extraordinary care' for a newborn with severe abnormalities, it means that aggressive interventions will not be pursued, allowing the newborn to die naturally. This decision is legal and ethical, respecting the principle of non-maleficence by avoiding unnecessary suffering. Choice A is incorrect because all individuals, including newborns, have rights, but the decision to withhold extraordinary care is based on ethical considerations. Choice B is incorrect as withholding care is not the same as euthanasia, which involves actively ending life. Choice C is incorrect as long as the decision is made within legal and ethical boundaries, it is not considered illegal professional practice.

2. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

• A. Begin positive pressure ventilations
• B. Provide blow-by oxygen with oxygen tubing
• C. Assess the newborn's skin condition and color
• D. Start chest compressions and contact medical control

Correct answer: A

Rationale: In a newborn, a heart rate below 100 beats/min indicates the need for positive pressure ventilation to improve oxygenation. Providing blow-by oxygen or assessing skin condition/color may not address the primary issue of inadequate oxygenation due to the low heart rate. Starting chest compressions and contacting medical control is not warranted as the newborn is breathing spontaneously and only has a slightly low heart rate, which can be managed initially with positive pressure ventilations.

3. A child sitting on a chair in a playroom starts to have a tonic-clonic seizure with a clenched jaw. What is the nurse’s best initial action?

• A. Attempt to open the jaw.
• B. Place the child on the floor.
• C. Call out for assistance from staff.
• D. Place a pillow under the child’s head.

Correct answer: B

Rationale: The correct initial action during a tonic-clonic seizure is to place the child on the floor to prevent injury. This action helps protect the child from falling off the chair and provides a safer environment for the seizure to occur. Attempting to open the jaw can cause harm or injury. Calling out for assistance is important but should follow the immediate action of moving the child to the floor. Placing a pillow under the child’s head is not recommended as it may lead to airway obstruction or further injury during the seizure.

4. Why should a nurse plan an evening snack for a child receiving Novolin N insulin?

• A. To encourage the child to adhere to the diet.
• B. To provide energy for immediate use.
• C. To help the child gain weight with extra calories.
• D. To counteract late insulin activity with nourishment.

Correct answer: D

Rationale: The correct answer is D. Novolin N insulin peaks in the evening, which can lead to hypoglycemia during the night. Providing an evening snack helps to counteract the late insulin activity and prevent hypoglycemia. Choice A is incorrect because the primary reason for the evening snack is not to encourage adherence to the diet. Choice B is incorrect as the snack is not primarily for immediate energy use. Choice C is incorrect as the goal of the snack is not to help the child gain weight but to manage blood sugar levels.

5. When working with a couple at risk of bearing a child with a genetic abnormality, what is most important for the nurse to incorporate into the plan of care?

• A. Gathering information from at least three generations
• B. Informing the couple of the need for a wide range of information
• C. Maintaining the confidentiality of the information
• D. Presenting the information in a nondirective manner

Correct answer: D

Rationale: When counseling a couple at risk of genetic abnormalities, it is crucial to present information in a nondirective manner. This approach allows the couple to make informed decisions without feeling pressured or influenced. Gathering information from at least three generations (Choice A) may be relevant for genetic counseling but is not the most critical aspect in this scenario. Informing the couple of the need for a wide range of information (Choice B) is too general and does not address the specific approach needed in this situation. Maintaining the confidentiality of the information (Choice C) is important but not the top priority compared to presenting information in a nondirective manner.

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