Nursing Elites

1. A nurse is reviewing laboratory results for a term newborn who is 24 hours old. Which of the following results require intervention by the nurse?

• A. WBC count 10,000/mm3
• B. Platelets 180,000/mm3
• C. Hemoglobin 20g/dL
• D. Glucose 20 mg/dL

Correct answer: D

Rationale: A glucose level of 20 mg/dL is critically low for a newborn and requires immediate intervention. Hypoglycemia in a newborn can lead to serious complications such as neurologic deficits. The normal range for glucose levels in a newborn is typically 40-60 mg/dL. Choices A, B, and C represent normal or acceptable values for a term newborn and do not require immediate intervention. A WBC count of 10,000/mm3, platelets of 180,000/mm3, and hemoglobin of 20g/dL are all within normal ranges for a term newborn and do not raise immediate concerns.

2. Rubella, also called German measles, is a viral infection passed from the mother to the fetus that can cause birth defects such as deafness, intellectual disabilities, blindness, and heart disease in the embryo.

• A. Rubella
• B. Syphilis
• C. Cystic fibrosis
• D. Phenylketonuria

Correct answer: A

Rationale: Rubella, also known as German measles, is a viral infection that can lead to severe birth defects when contracted by a mother during pregnancy. Rubella is the correct answer because it is specifically associated with causing birth defects such as deafness, intellectual disabilities, blindness, and heart disease in the embryo. Syphilis (Choice B) can be passed from mother to fetus but does not cause the mentioned birth defects associated with Rubella. Cystic fibrosis (Choice C) and Phenylketonuria (Choice D) are genetic conditions and not infections transmitted from mother to fetus, making them incorrect choices in this context.

3. A woman has experienced iron deficiency anemia during her pregnancy. She had been taking iron for 3 months before the birth. The client gave birth by cesarean 2 days earlier and has been having problems with constipation. After assisting her back to bed from the bathroom, the nurse notes that the woman’s stools are dark (greenish-black). What should the nurse’s initial action be?

• A. Perform a guaiac test and record the results.
• B. Recognize the finding as abnormal and report it to the primary health care provider.
• C. Recognize the finding as a normal result of iron therapy.
• D. Check the woman’s next stool to validate the observation.

Correct answer: C

Rationale: The nurse should recognize that dark stools are a common side effect in clients who are taking iron replacement therapy. Dark stools are a known, expected result of iron supplementation and are not indicative of a complication unless other symptoms of GI bleeding are present. A guaiac test would be necessary if there were concerns about gastrointestinal bleeding. Recognizing dark stools as a consequence of iron therapy is an essential nursing assessment skill and does not require immediate reporting. Checking the next stool to confirm the observation is unnecessary as the presence of dark stools in this context is already an expected outcome of iron supplementation.

4. A client experiencing preterm labor is being taught about terbutaline by a nurse. Which statement by the client indicates an understanding of the teaching?

• A. “The medication could cause me to experience heart palpitations.”
• B. “This medication could cause me to experience blurred vision.”
• C. “This medication could cause me to experience ringing in my ears.”
• D. “This medication could cause me to experience frequent urination.”

Correct answer: A

Rationale: The correct answer is A. Terbutaline is a beta-adrenergic agonist used to stop preterm labor. One of its common side effects is heart palpitations due to its action on beta receptors in the heart. Choices B and C are incorrect because blurred vision and ringing in the ears are not common side effects of terbutaline. Choice D is irrelevant to the side effects of terbutaline.

5. Which of the following statements is true of Down’s syndrome?

• A. Down’s syndrome is usually caused by an extra copy of chromosome 21 in an individual.
• B. The symptoms of Down’s syndrome are similar to those of sickle-cell anemia.
• C. Down’s syndrome is caused by a sexually transmitted infection (STI) during conception.
• D. The probability of having a child with Down’s syndrome increases with the age of the parents.

Correct answer: D

Rationale: The correct answer is D. The likelihood of having a child with Down’s syndrome increases as the age of the parents increases, particularly the mother's age. Choice A is incorrect because Down’s syndrome is caused by an extra copy of chromosome 21, not a defect in the sex chromosomes. Choice B is incorrect as the symptoms of Down’s syndrome and sickle-cell anemia are different. Choice C is also incorrect as Down’s syndrome is not caused by a sexually transmitted infection during conception.

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