Nursing Elites

1. The healthcare provider is assessing a 38-week gestation newborn infant immediately following a vaginal birth. Which assessment finding best indicates that the infant is transitioning well to extrauterine life?

• A. Positive Babinski reflex.
• B. Flexion of all four extremities.
• C. Heart rate of 220 beats/min.
• D. Cries vigorously when stimulated.

Correct answer: D

Rationale: A vigorous cry upon stimulation indicates that the newborn has good respiratory effort and is transitioning well to life outside the womb. It shows that the infant's airways are clear, and they are able to establish effective breathing, a crucial aspect of transitioning successfully to extrauterine life. Choices A, B, and C are not the best indicators of successful transition to extrauterine life. The Babinski reflex and flexion of extremities are normal neonatal reflexes and do not specifically indicate successful transition. A heart rate of 220 beats/min is abnormally high for a newborn and could indicate distress rather than a smooth transition.

2. To confirm respiratory distress syndrome (RDS) in a newborn, what should the nurse assess?

• A. Assess diaphragmatic breathing.
• B. Assess heart sounds.
• C. Monitor blood oxygen levels.
• D. Check for signs of infection.

Correct answer: A

Rationale: To confirm respiratory distress syndrome (RDS) in a newborn, the nurse should assess diaphragmatic breathing. In RDS, the baby may have difficulty breathing due to immature lungs, leading to shallow, rapid breathing movements. Assessing diaphragmatic breathing directly evaluates the respiratory effort and can help identify the presence of RDS. Choice B, assessing heart sounds, is not specific to diagnosing RDS but could be relevant for other conditions. Choice C, monitoring blood oxygen levels, is important but alone may not confirm RDS. Choice D, checking for signs of infection, is not a direct indicator of RDS but rather suggests a different issue.

3. During the newborn admission assessment, the nurse palpates the newborn's scrotum and does not feel the testicles. Which assessment technique should the nurse perform next to verify the absence of testes?

• A. Observe the urethral opening on the surface of the penis when the newborn voids.
• B. Perform transillumination of the scrotal sac to visualize shadows of the testes.
• C. Use a fingertip to palpate the inguinal canal for a retractile or undescended testis.
• D. Measure the size of the scrotal sac for length and width.

Correct answer: C

Rationale: If the testes are not palpated in the scrotum, the next step is to check the inguinal canal for a retractile or undescended testis. This technique allows the nurse to determine if the testes are located within the inguinal canal rather than the scrotum. It is essential to assess for the presence of testes in the inguinal canal to ensure proper diagnosis and management of any potential issues related to testicular positioning.

4. The healthcare provider is reviewing the serum laboratory findings for a 5-day-old infant with congenital adrenal hyperplasia. Which laboratory result should be reported to the healthcare provider immediately?

• A. Bilirubin of 1.5 mg/dl.
• B. Glucose of 80 mg/dl.
• C. Potassium of 4.5 mEq/L.
• D. Sodium of 119 mEq/L.

Correct answer: D

Rationale: Low sodium levels in congenital adrenal hyperplasia can indicate salt-wasting crisis, which is a life-threatening emergency requiring immediate medical attention. Monitoring sodium levels is crucial to prevent complications such as dehydration and shock in these patients.

5. A neonate with congenital adrenal hypoplasia (CAH) presents with ambiguous genitalia. What is the primary nursing consideration when supporting the parents of a child with this anomaly?

• A. Discuss the need for cortisol and aldosterone replacement therapy after discharge
• B. Support the parents in their decision regarding the sex assignment of their child
• C. Offer information about ultrasonography and genotyping to determine sex assignment
• D. Explain that corrective surgical procedures consistent with sex assignment can be delayed

Correct answer: B

Rationale: Supporting the parents in their decision regarding the sex assignment of their child is crucial as it respects the parental role in making this important decision and helps provide emotional support during a challenging time. The primary focus should be on helping the parents navigate the complexities and implications of determining the sex assignment for their child with ambiguous genitalia.

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