Nursing Elites

1. A healthcare provider is teaching a prenatal class about immunizations that newborns receive following birth. Which of the following immunizations should the provider include in the teaching?

• A. Hepatitis B
• B. Rotavirus
• C. Pneumococcal
• D. Varicella

Correct answer: A

Rationale: The correct answer is Hepatitis B. Newborns receive the Hepatitis B vaccine shortly after birth to provide protection against the virus. Rotavirus, Pneumococcal, and Varicella vaccines are typically administered at later stages of infancy or childhood, not immediately after birth. Rotavirus vaccine helps prevent severe diarrhea, Pneumococcal vaccine protects against infections like pneumonia and meningitis, and Varicella vaccine prevents chickenpox. However, these vaccines are not part of the routine immunizations given to newborns immediately after birth.

2. Following a traumatic delivery, an infant receives an initial Apgar score of 3. Which intervention is most important for the nurse to implement?

• A. Page the pediatrician STAT
• B. Continue resuscitative efforts
• C. Repeat the Apgar assessment in 5 minutes
• D. Inform the parents of the infant's condition

Correct answer: B

Rationale: In a situation where an infant receives a low Apgar score of 3 following a traumatic delivery, the most crucial intervention for the nurse to implement is to continue resuscitative efforts. A low Apgar score indicates that the newborn is in distress and requires immediate medical attention to support breathing, heart rate, muscle tone, reflex irritability, and color. Continuing resuscitative efforts is essential to provide life-saving interventions promptly. Paging the pediatrician may cause a delay in crucial interventions, repeating the Apgar assessment in 5 minutes is not appropriate as immediate action is needed to stabilize the infant, and informing parents should not take precedence over providing immediate medical care to the newborn.

3. A nurse is developing an educational program about hemolytic diseases in newborns for a group of newly licensed nurses. Which of the following genetic information should the nurse include in the program as a cause of hemolytic disease?

• A. The mother is Rh positive, and the father is Rh negative
• B. The mother is Rh negative, and the father is Rh positive
• C. The mother and the father are both Rh positive
• D. The mother and the father are both Rh negative

Correct answer: B

Rationale: The correct answer is B: 'The mother is Rh negative, and the father is Rh positive.' Hemolytic disease of the newborn occurs when an Rh-negative mother carries an Rh-positive fetus, leading to Rh incompatibility. In this scenario, the mother produces antibodies against the Rh antigen present in the fetus, which can result in hemolysis of the fetal red blood cells. Choices A, C, and D do not describe the Rh incompatibility that leads to hemolytic disease in newborns. Therefore, they are incorrect.

4. Which statement by the client will assist the healthcare provider in determining whether she is in true labor as opposed to false labor?

• A. I passed some thick, pink mucus when I urinated this morning.
• B. My bag of waters just broke.
• C. The contractions in my uterus are getting stronger and closer together.
• D. My baby dropped, and I have to urinate more frequently now.

Correct answer: C

Rationale: The correct answer is C. Regular, strong contractions with the presence of cervical change indicate that the woman is experiencing true labor. Choice A indicates the passing of the mucus plug, which is a sign of early labor but not definitive for true labor. Choice B, the breaking of the bag of waters, is a sign of labor but does not confirm whether it is true or false labor. Choice D, the baby dropping and increased urination frequency, suggests lightening, a sign that labor may be approaching, but it does not confirm true labor.

5. A newborn who was born post-term is being assessed by a nurse. Which of the following findings should the nurse expect?

• A. A Rh-negative mother who has an Rh-positive infant
• B. A Rh-positive mother who has an Rh-negative infant
• C. A Rh-positive mother who has an Rh-positive infant
• D. A Rh-negative mother who has an Rh-negative infant

Correct answer: A

Rationale: The correct answer is A: 'A Rh-negative mother who has an Rh-positive infant.' In cases where the newborn is born post-term, the mismatched Rh factor between the mother (Rh-negative) and the infant (Rh-positive) can lead to hemolytic disease of the newborn. This condition occurs when maternal antibodies attack fetal red blood cells, causing hemolysis. This can result in jaundice, anemia, and other serious complications for the infant. Choices B, C, and D are incorrect because they do not reflect the mismatched Rh factor scenario that poses a risk for hemolytic disease of the newborn.

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