Nursing Elites

1. A client who is 28 weeks pregnant and not up-to-date on current immunizations should anticipate receiving which of the following immunizations following birth?

• A. Pneumococcal
• B. Hepatitis
• C. Human papillomavirus
• D. Rubella

Correct answer: D

Rationale: The correct answer is D, Rubella. Rubella vaccine is recommended postpartum to prevent congenital rubella syndrome in future pregnancies. Pneumococcal and Hepatitis vaccines are not routinely given postpartum. Human papillomavirus vaccine is not typically administered immediately after birth but rather at a later age to prevent HPV infections.

2. A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?

• A. Provide a calm environment
• B. Monitor blood glucose levels every hour
• C. Initiate seizure precautions
• D. Place the infant on their back with legs extended

Correct answer: C

Rationale: Initiating seizure precautions is crucial when caring for an infant with neonatal abstinence syndrome due to the increased risk of seizures. Providing a calm environment (Choice A) is important to reduce stimulation as these infants may be irritable. Monitoring blood glucose levels (Choice B) is not typically a priority in neonatal abstinence syndrome unless specific signs or symptoms suggest the need for this assessment. Placing the infant on their back with legs extended (Choice D) does not directly address the potential complications associated with neonatal abstinence syndrome, such as seizures.

3. A client who is 5 days postpartum is being taught about signs of effective breastfeeding. Which information should the nurse include in the teaching?

• A. Feeling a tugging sensation when the baby is sucking
• B. Expecting the baby to have two to three wet diapers in a 24-hour period
• C. The baby’s urine should appear dark and concentrated
• D. The breast should stay firm after the baby breastfeeds

Correct answer: A

Rationale: Feeling a tugging sensation while the baby is sucking indicates an effective latch and milk transfer during breastfeeding. This sensation means that the baby is effectively drawing milk from the breast. Choice B is incorrect because infants should ideally have six to eight wet diapers in a 24-hour period to show adequate hydration. Choice C is incorrect as a dark and concentrated urine may indicate dehydration, which is not a sign of effective breastfeeding. Choice D is incorrect as the breast should soften after the baby breastfeeds, indicating that the baby has effectively emptied the breast of milk.

4. Rh incompatibility occurs when an Rh-negative woman is carrying an Rh-positive fetus.

• A. TRUE
• B. FALSE
• C. Sometimes
• D. Never

Correct answer: B

Rationale: Rh incompatibility occurs when an Rh-negative woman is carrying an Rh-positive fetus, not the other way around. Therefore, the statement that an Rh-positive woman is carrying an Rh-negative fetus is incorrect. Rh incompatibility can lead to hemolytic disease of the newborn, where maternal antibodies attack the fetal red blood cells. Choice A is incorrect because the statement is false. Choice C is incorrect as Rh incompatibility has a clear cause and effect relationship. Choice D is incorrect as Rh incompatibility can occur, but it depends on the Rh status of the mother and fetus.

5. A healthcare provider is assessing a newborn upon admission to the nursery. Which of the following should the provider expect?

• A. Bulging Fontanels
• B. Nasal Flaring
• C. Length from head to heel of 40 cm (15.7 in)
• D. Chest circumference 2 cm (0.8 in) smaller than the head circumference

Correct answer: D

Rationale: Upon admission to the nursery, a healthcare provider should expect the newborn's chest circumference to be slightly smaller than the head circumference. This is a normal finding in newborns due to their physiological development. Bulging fontanels (Choice A) can indicate increased intracranial pressure, which is abnormal. Nasal flaring (Choice B) is a sign of respiratory distress and is also an abnormal finding. While a length from head to heel of 40 cm (15.7 in) (Choice C) falls within the normal range for newborns, it is not a specific expectation upon admission to the nursery. Therefore, the correct expectation for a newborn upon admission is for the chest circumference to be slightly smaller than the head circumference.

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