Nursing Elites

1. A nurse is providing education about family bonding to parents who recently adopted a newborn. The nurse should make which of the following suggestions to aid the family's 7-year-old child in accepting the new family member?

• A. Allow the sibling to hold the newborn during a bath.
• B. Make sure the sibling kisses the newborn each night.
• C. Obtain a gift from the newborn to present to the sibling.
• D. Switch the sibling's room with the nursery.

Correct answer: C

Rationale: To help a 7-year-old child accept a new family member, it is important to involve them in the process. Obtaining a gift from the newborn to present to the sibling is a thoughtful gesture that can make the older child feel included and valued in the family dynamic. This strategy fosters a sense of connection and understanding between the siblings, promoting acceptance and bonding. Choices A, B, and D are incorrect as they do not directly involve the older sibling in a positive and inclusive manner. Allowing the sibling to hold the newborn during a bath or making them kiss the newborn might not resonate well with the 7-year-old and could potentially create negative feelings. Switching the sibling's room with the nursery is a major change that may not necessarily promote acceptance and bonding, and it could lead to feelings of displacement or confusion.

2. While caring for a newborn, a nurse auscultates an apical heart rate of 130/min. Which of the following actions should the nurse take?

• A. Ask another nurse to verify the heart rate.
• B. Document this as an expected finding.
• C. Call the provider to further assess the newborn.
• D. Prepare the newborn for transport to the NICU.

Correct answer: B

Rationale: An apical heart rate of 130/min is within the expected range for a newborn. It is not necessary to seek verification from another nurse, call the provider for further assessment, or prepare for NICU transport based on this heart rate. Documenting the heart rate as an expected finding is the appropriate action in this situation as it falls within the normal range for a newborn's heart rate.

3. An adolescent is being taught about levonorgestrel contraception by a school nurse. What information should the nurse include in the teaching?

• A. You should take the medication within 72 hours following unprotected sexual intercourse.
• B. Do not take this medication if you are on an oral contraceptive.
• C. If you do not start your period within 5 days of taking this medication, you will need a pregnancy test.
• D. One dose of this medication will prevent pregnancy for 14 days after taking it.

Correct answer: A

Rationale: Levonorgestrel is an emergency contraceptive that works by inhibiting ovulation to prevent conception. It is most effective when taken as soon as possible within 72 hours following unprotected sexual intercourse. Therefore, the nurse should instruct the adolescent to take the medication promptly to maximize its effectiveness. Choice B is incorrect because levonorgestrel can be used even if the individual is on oral contraceptives. Choice C is incorrect as the efficacy of levonorgestrel is not determined by the onset of menstruation. Choice D is incorrect because levonorgestrel is a single-dose emergency contraceptive and does not provide protection for 14 days after ingestion.

4. A client is being discharged after childbirth. At 4 weeks postpartum, the client should contact the provider for which of the following client findings?

• A. Scant, non-odorous white vaginal discharge
• B. Uterine cramping during breastfeeding
• C. Sore nipple with cracks and fissures
• D. Decreased response with sexual activity

Correct answer: C

Rationale: Sore nipples with cracks and fissures should be reported to the provider as this can indicate improper breastfeeding techniques or infection, which requires medical evaluation and intervention to prevent further complications such as mastitis or decreased milk supply. Scant, non-odorous white vaginal discharge is a normal finding postpartum. Uterine cramping during breastfeeding is also common due to oxytocin release. Decreased response with sexual activity may be expected at 4 weeks postpartum due to hormonal changes and fatigue, but it is not typically a concern that needs immediate medical attention.

5. A client in a family planning clinic requests oral contraceptives. Which of the following findings in the client's history should be recognized as contraindications to oral contraceptives? (Select all that apply.)

• A. Cholecystitis
• B. Hypertension
• C. Migraine headaches
• D. All of the above

Correct answer: D

Rationale: Cholecystitis is a correct answer. A history of gallbladder disease, such as cholecystitis, is a contraindication for the use of oral contraceptives. Hypertension is a correct answer. Hypertension is also a contraindication for the use of oral contraceptives due to the increased risk of complications. Migraine headaches are a correct answer. A history of migraine headaches is a contraindication for the use of oral contraceptives, especially for those with aura. Selecting 'All of the above' is correct as all the mentioned conditions (cholecystitis, hypertension, and migraine headaches) are contraindications for oral contraceptives. Human papillomavirus and anxiety disorder are incorrect choices as they are not contraindications for the use of oral contraceptives.

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