Nursing Elites

1. Why is a prolapsed umbilical cord dangerous?

• A. The cord may be wrapped around the baby's neck, causing strangulation.
• B. The cord might pull the placenta from the uterine wall during delivery.
• C. The baby's head may compress the cord, cutting off its supply of oxygen.
• D. The mother may die of hypoxia due to compromised placental blood flow.

Correct answer: C

Rationale: A prolapsed umbilical cord is dangerous because the baby's head may compress the cord, cutting off its supply of oxygen. This compression can lead to oxygen deprivation, potentially causing significant harm to the baby. Immediate medical intervention is crucial in such cases to prevent adverse outcomes.

2. What intervention should the nurse encourage for a postpartum client complaining of perineal pain?

• A. Use of ice packs for the first 24 hours
• B. Application of heat packs immediately
• C. Avoiding the use of peri-bottles
• D. Using tampons to manage lochia

Correct answer: A

Rationale: The correct intervention for perineal pain in a postpartum client is the use of ice packs for the first 24 hours. Ice packs help reduce swelling and discomfort in the perineal area, especially during the initial post-delivery period. Applying heat packs can exacerbate swelling and discomfort. Avoiding peri-bottles may lead to poor perineal hygiene. Using tampons is contraindicated postpartum as it increases the risk of infection.

3. The nurse is using the New Ballard Score to assess the gestational age of a newborn delivered 4 hours ago. The infant's gestational age is 33 weeks based on early ultrasound and last menstrual period. The nurse expects the infant to exhibit which of the following?

• A. Full sole creases, nails extending beyond the fingertips, scarf sign showing the elbow beyond the midline
• B. Testes located in the upper scrotum, rugae covering the scrotum, vernix covering the entire body
• C. Ear cartilage folded over, lanugo present over much of the body, slow recoil time
• D. 1 cm breast bud, peeling skin and veins not visible, rapid recoil of legs and arms to extension

Correct answer: C

Rationale: The correct answer is C. Ear cartilage folded over, lanugo present over much of the body, and slow recoil time are all characteristics of a preterm infant. A is incorrect because full sole creases, nails extending beyond the fingertips, and scarf sign showing the elbow beyond the midline are features of a term infant. B is incorrect as testes located in the upper scrotum, rugae covering the scrotum, and vernix covering the entire body are also indicative of a term infant. D is incorrect because a 1 cm breast bud, peeling skin and veins not visible, and rapid recoil of legs and arms to extension are characteristics seen in a more mature infant, not a preterm newborn.

4. When you attempt to assess a 22-year-old woman who has been sexually assaulted, she orders you not to touch her. Your MOST appropriate initial action should be to:

• A. obtain a signed refusal and return to service.
• B. transport the patient without performing an assessment.
• C. explain to the patient that she must be examined.
• D. ask a female EMT to attempt to assess the patient.

Correct answer: D

Rationale: In cases of sexual assault, it's important to respect the patient's wishes and provide a female EMT to attempt the assessment if the patient prefers.

5. Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques?

• A. Dietary changes
• B. Multivitamins
• C. Smoking cessation
• D. Limiting caffeine

Correct answer: B

Rationale: Multivitamins are not typically considered a non-pharmacological technique for lowering blood pressure. While dietary changes, smoking cessation, and limiting caffeine intake can positively impact blood pressure levels, multivitamins are generally not specifically recommended as a primary intervention for this purpose. Dietary changes can include reducing salt intake and increasing potassium-rich foods, which are known to help manage blood pressure. Smoking cessation is crucial due to the negative impact of smoking on blood pressure and overall cardiovascular health. Limiting caffeine intake is advised as excessive caffeine consumption can lead to a temporary increase in blood pressure. Therefore, focusing on lifestyle modifications like healthy eating, smoking cessation, and caffeine reduction is more effective in managing blood pressure than relying on multivitamins.

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