Nursing Elites

1. A newborn nursery protocol includes a prescription for ophthalmic erythromycin 5% ointment to both eyes upon a newborn's admission. What action should the nurse take to ensure adequate installation of the ointment?

• A. Instill a thin ribbon into each lower conjunctival sac
• B. Occlude the inner canthus after retracting the eyelids
• C. Mummy wrap the infant before instilling the ointment
• D. Stabilize the instilling hand on the neonate's head

Correct answer: A

Rationale: To ensure adequate installation of the ophthalmic erythromycin 5% ointment in a newborn, the nurse should instill a thin ribbon into each lower conjunctival sac. This method helps to ensure proper distribution and effectiveness of the medication to prevent neonatal conjunctivitis. Choices B, C, and D are incorrect. Occluding the inner canthus after retracting the eyelids, mummy wrapping the infant, or stabilizing the instilling hand on the neonate's head are not appropriate actions for ensuring the proper installation of the ointment.

2. What is the purpose of amniocentesis?

• A. To induce abortion
• B. To detect genetic abnormalities in the fetus
• C. To determine the baby's gender
• D. To monitor fetal growth

Correct answer: B

Rationale: Amniocentesis is a diagnostic procedure used to detect genetic abnormalities in the fetus, such as chromosomal disorders like Down syndrome. It is not performed to induce abortion. The primary purpose of amniocentesis is to assess the genetic health of the fetus, not to determine the baby's gender (Choice C). While amniocentesis can provide information about the baby's health and development, it is not primarily used for monitoring fetal growth (Choice D). Therefore, the correct answer is B.

3. A client in the transition phase of labor reports a pain level of 7 on a scale of 0 to 10. Which of the following actions should the nurse take?

• A. Instruct the client to use effleurage.
• B. Apply counterpressure to the client's sacrum.
• C. Assist the client with patterned-paced breathing.
• D. Teach the client the technique of biofeedback.

Correct answer: B

Rationale: During the transition phase of labor, a client may experience intense back pain due to the pressure of the baby descending. Applying counterpressure to the client's sacrum can help alleviate this discomfort. Effleurage is a light stroking massage technique that may not provide adequate relief for intense back pain. Patterned-paced breathing is beneficial for managing contractions but may not directly address back pain. Biofeedback is a technique that helps individuals gain awareness and control of certain physiological functions, but it may not be the most appropriate intervention for acute labor pain.

4. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

• A. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
• B. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
• C. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
• D. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Correct answer: B

Rationale: Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.

5. A newborn assessment reveals spina bifida occulta. Which maternal factor should the nurse identify as having the greatest impact on the development of this newborn complication?

• A. Tobacco use.
• B. Folic acid deficiency.
• C. Short interval between pregnancies.
• D. Preeclampsia.

Correct answer: B

Rationale: Folic acid deficiency during pregnancy is strongly associated with neural tube defects like spina bifida occulta. Adequate folic acid intake before and during early pregnancy significantly reduces the risk of such complications. Tobacco use (Choice A) is linked to other adverse outcomes but not specifically spina bifida occulta. Short intervals between pregnancies (Choice C) can increase the risk of preterm birth and low birth weight but are not directly linked to spina bifida occulta. Preeclampsia (Choice D) is a hypertensive disorder that poses risks to both the mother and baby but is not the primary factor contributing to spina bifida occulta development.

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