Nursing Elites

1. The LPN/LVN is counseling a woman who wants to become pregnant. The woman tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. The nurse calculates that the woman's next fertile period is

• A. January 14-15.
• B. January 22-23.
• C. January 30-31.
• D. February 6-7.

Correct answer: C

Rationale: To determine the fertile period, subtract 14 days from the length of the woman's menstrual cycle. In this case, 36-14 = 22. Counting forward from the first day of the last menstrual period (January 8), the fertile period falls around January 30-31. This is because ovulation typically occurs approximately 14 days before the start of the next menstrual period, marking the fertile window for conception.

2. A 34-week primigravida woman with preeclampsia is receiving Lactated Ringer’s 500ml with magnesium sulfate 20 grams at the rate of 3g/hr. How many ml/hr should the nurse program the infusion pump?

• A. 75ml/hr
• B. 100ml/hr
• C. 50ml/hr
• D. 25ml/hr

Correct answer: A

Rationale: To calculate the infusion rate, divide the total quantity to be infused (500ml) by the total time (1 hour) which equals 500ml/hr. Since the magnesium sulfate is being given at 3g/hr, and 1g of magnesium sulfate is in 5ml of solution, the rate will be 3g/hr x 5ml/g = 15ml/hr. Therefore, the total infusion rate should be 500ml/hr + 15ml/hr = 515ml/hr. Hence, the nurse should program the infusion pump to deliver 75ml/hr (515ml/hr total - 500ml/hr Lactated Ringer's rate). This choice is correct because it accounts for both the Lactated Ringer's and magnesium sulfate rates. Choice B, 100ml/hr, is incorrect as it does not consider the additional magnesium sulfate infusion rate. Choice C, 50ml/hr, is incorrect because it does not account for the magnesium sulfate infusion. Choice D, 25ml/hr, is incorrect as it is too low and does not consider the magnesium sulfate being infused concurrently.

3. A breastfeeding infant, screened for congenital hypothyroidism, is found to have low levels of thyroxine (T4) and high levels of thyroid-stimulating hormone (TSH). What is the best explanation for this finding?

• A. The thyroxine level is low because the TSH level is high.
• B. High thyroxine levels do not normally occur in breastfeeding infants.
• C. The thyroid gland does not produce normal levels of thyroxine for several weeks after birth.
• D. The TSH is high because of the low production of T4 by the thyroid.

Correct answer: D

Rationale: High TSH and low T4 levels indicate that the thyroid gland is not producing enough hormones, which is a sign of congenital hypothyroidism. In this case, the high TSH is a compensatory response by the body to stimulate the thyroid to produce more T4. Choice A is incorrect because TSH does not directly affect T4 levels; rather, it is the other way around where low T4 levels lead to high TSH levels. Choice B is incorrect because high thyroxine levels are not expected in congenital hypothyroidism. Choice C is incorrect as the thyroid gland should be producing normal levels of thyroxine shortly after birth, making this explanation unlikely in the context of congenital hypothyroidism.

4. A primipara patient asks what is the best pet to have at home to share time with. Which pet is not recommended?

• A. Dog
• B. Cat
• C. Bird
• D. Fish

Correct answer: C

Rationale: Birds are not recommended as pets for a primipara patient due to potential health risks associated with bird droppings, feathers, and dander. These factors may pose a risk to the newborn's health and the mother's well-being. Additionally, some birds can be loud, which may disrupt the baby's sleep patterns. Therefore, it is advisable for primipara patients to consider pets like dogs, cats, or fish as they generally have lower associated risks in a household with a newborn. Dogs, cats, and fish are relatively safer options compared to birds for primipara patients due to their lower risk of transmitting infections, allergens, or causing disturbances that could affect the newborn or the mother.

5. After each feeding, a 3-day-old newborn is spitting up large amounts of Enfamil® Newborn Formula, a nonfat cow's milk formula. The pediatric healthcare provider changes the neonate's formula to Similac® Soy Isomil® Formula, a soy protein isolate-based infant formula. What information should the LPN/LVN provide to the mother about the newly prescribed formula?

• A. The new formula is a coconut milk formula used with babies with impaired fat absorption.
• B. Enfamil® Formula is a demineralized whey formula that is needed with diarrhea.
• C. The new formula is a casein protein source that is low in phenylalanine.
• D. Similac® Soy Isomil® Formula is a soy-based formula that contains sucrose.

Correct answer: D

Rationale: The LPN/LVN should inform the mother that Similac® Soy Isomil® Formula is a soy-based formula containing sucrose. This formula is suitable for infants with cow's milk protein allergy or intolerance, which may be the reason for the newborn spitting up large amounts of the previous cow's milk formula.

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