Nursing Elites

1. A parent is receiving discharge teaching from a nurse regarding caring for their newborn after a circumcision. Which instruction should the nurse include?

• A. Apply slight pressure with a sterile gauze pad for mild bleeding.
• B. Inspect the circumcision site every 6 to 8 hours.
• C. Avoid using baby wipes containing alcohol to cleanse the penis with each diaper change.
• D. Clean the circumcision site daily using a warm, wet washcloth.

Correct answer: A

Rationale: The correct answer is to apply slight pressure with a sterile gauze pad for mild bleeding. This helps to stop bleeding. If the bleeding persists, the parent should contact the healthcare provider for further guidance. While inspecting the circumcision site is important, checking every 6 to 8 hours might be too frequent and could disrupt healing. Using baby wipes containing alcohol can irritate the sensitive skin, so it is advised to avoid them. Cleaning the circumcision site daily is crucial, but excessive cleaning by removing yellow exudate daily is not necessary unless advised by the healthcare provider.

2. A newborn was transferred to the nursery 30 min after delivery. What should the nurse do first?

• A. Confirm the newborn's identification.
• B. Verify the newborn's identification.
• C. Administer vitamin K to the newborn.
• D. Determine obstetrical risk factors.

Correct answer: B

Rationale: When a newborn is transferred to the nursery, the first action the nurse should take is to verify the newborn's identification. This step is crucial for ensuring the correct care is provided to the right newborn, promoting patient safety and preventing errors. Administering vitamin K (Choice C) is important but should not be the first action. Determining obstetrical risk factors (Choice D) is not the priority when the newborn is transferred to the nursery. Confirming (Choice A) and verifying (Choice B) have similar meanings, but 'verify' is a more appropriate term in this context.

3. A nurse in the emergency department is caring for a client who reports abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding. The client states, 'I missed one menstrual cycle and cannot be pregnant because I have an intrauterine device.' The nurse should suspect which of the following?

• A. Missed abortion
• B. Ectopic pregnancy
• C. Severe preeclampsia
• D. Hydatidiform mole

Correct answer: B

Rationale: Ectopic pregnancy should be suspected in clients with abrupt, sharp, right-sided lower quadrant abdominal pain and bright red vaginal bleeding, especially if they have an intrauterine device (IUD). In this case, the client's symptoms are classic for ectopic pregnancy, where the fertilized egg implants outside the uterus, commonly in the fallopian tube. Missed abortion (choice A) refers to a nonviable embryo or fetus in the uterus, which is not consistent with the client's presentation. Severe preeclampsia (choice C) is characterized by hypertension and proteinuria, not the symptoms described. Hydatidiform mole (choice D) presents with vaginal bleeding but typically lacks abdominal pain and is not related to the presence of an IUD.

4. A client who is 6 hours postpartum and Rh-negative has an Rh-positive newborn. The client asks why an indirect Coombs test was ordered. Which of the following is an appropriate response by the healthcare provider?

• A. It determines if kernicterus will occur in the newborn.
• B. It detects Rh-negative antibodies in the newborn's blood.
• C. It detects Rh-positive antibodies in the mother's blood.
• D. It determines the presence of maternal antibodies in the newborn's blood.

Correct answer: C

Rationale: The indirect Coombs test is performed to detect Rh-positive antibodies in the mother's blood. In cases where the mother is Rh-negative and the baby is Rh-positive, the mother may develop antibodies against the baby's blood cells, which can lead to hemolytic disease of the newborn. Choice A is incorrect because kernicterus is a complication of severe jaundice, not directly assessed by the indirect Coombs test. Choice B is incorrect as the test aims to detect Rh-positive antibodies, not Rh-negative antibodies in the newborn's blood. Choice D is incorrect as the test is focused on detecting antibodies in the mother's blood, not the newborn's.

5. A nurse is assisting with an in-service for newly licensed nurses about neonatal abstinence syndrome in newborns. Which of the following statements by a newly licensed nurse indicates an understanding of the teaching?

• A. The newborn will have decreased muscle tone.
• B. The newborn will have a continuous high-pitched cry.
• C. The newborn will sleep for 2 to 3 hours after a feeding.
• D. The newborn will have mild tremors when disturbed.

Correct answer: B

Rationale: The correct answer is B. A continuous high-pitched cry is a characteristic sign of neonatal abstinence syndrome, indicating withdrawal from drugs. Choices A, C, and D are incorrect because decreased muscle tone, sleeping for 2 to 3 hours after a feeding, and mild tremors when disturbed are not specific indicators of neonatal abstinence syndrome.

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