Nursing Elites

1. The student nurse has performed a gestational age assessment of an infant and finds the infant to be at 32 weeks. On which set of characteristics is the nurse basing this assessment?

• A. Lanugo mostly gone, little vernix remaining on the body
• B. Prominent clitoris, enlarging labia minora, patent anus
• C. Full areola, 5 to 10 mm nipple bud, pinkish-brown areola
• D. Skin opaque, cracking at wrists and ankles, no visible vessels

Correct answer: B

Rationale: The correct answer is B. At 30 to 32 weeks' gestation, the clitoris is prominent, and the labia minora are enlarging. The labia majora are small and widely separated. As gestational age increases, the labia majora increase in size. At 36 to 40 weeks, they almost cover the clitoris. At 40 weeks and beyond, the labia majora cover the labia minora and clitoris. Choices A, C, and D do not align with the characteristic features seen at 32 weeks of gestation, making them incorrect.

2. Which of the following is a more reliable indicator of perfusion in children than in adults?

• A. Blood pressure
• B. Heart rate
• C. Respiratory rate
• D. Capillary refill

Correct answer: D

Rationale: Capillary refill is a more reliable indicator of perfusion in children than in adults. This is because children have more compliant vessels, making capillary refill a more sensitive indicator of perfusion status in this population. In contrast, while blood pressure, heart rate, and respiratory rate are important indicators, they may not be as reliable in children as capillary refill. Blood pressure can be affected by various factors such as anxiety or pain, heart rate can be influenced by emotions or temperature, and respiratory rate may vary with activity levels. Therefore, capillary refill is preferred in children for a more accurate assessment of perfusion.

3. When assessing a 30-year-old female in labor, what should the EMT do?

• A. Ask the mother when she is expecting to deliver.
• B. Avoid questioning the patient about her medical history.
• C. Determine the stage of her labor by examining her.
• D. Recall that delivery is imminent if she is crowning.

Correct answer: D

Rationale: During the assessment of a 30-year-old female in labor, the EMT should be aware that delivery is imminent if she is crowning. Crowning indicates that the baby's head is visible at the vaginal opening, signaling that the birth is progressing rapidly and the baby will soon be delivered. This is a critical moment that requires preparedness for the birth process and ensuring a safe delivery environment. Choice A is incorrect because asking the mother when she is expecting to deliver is not relevant when the baby's head is visible at the vaginal opening. Choice B is incorrect as obtaining the patient's medical history is essential for providing appropriate care. Choice C is incorrect because determining the stage of labor by examining the patient is important but recognizing crowning indicates that delivery is imminent and requires immediate action.

4. A patient has been diagnosed with hypothyroidism; the nurse tells the patient not to eat goitrogens. Which of the following is an example of a goitrogen?

• A. Orange
• B. Tomatoes
• C. Cabbage
• D. Grapes

Correct answer: C

Rationale: Cabbage is an example of a goitrogen. Goitrogens are substances that can interfere with thyroid function by inhibiting the uptake of iodine. Cabbage contains compounds that can have this effect and should be consumed in moderation by individuals with hypothyroidism.

5. A breastfeeding mother reports breast engorgement. The nurse advises her to:

• A. Increase the frequency of feedings
• B. Apply ice packs to the breasts
• C. Avoid breastfeeding until the pain subsides
• D. Use a breast pump to empty the breasts completely

Correct answer: A

Rationale: Breast engorgement occurs when the breasts become overfilled with milk. By increasing the frequency of feedings, the mother can ensure that her breasts are emptied regularly, helping to relieve the discomfort associated with engorgement. This advice promotes effective milk removal and prevents further accumulation, which can worsen the condition. Applying ice packs may provide temporary relief, but it does not address the underlying issue of milk accumulation. Avoiding breastfeeding can lead to further engorgement and potential complications. Using a breast pump to empty the breasts completely may be necessary in some cases, but increasing the frequency of feedings is the initial and most appropriate intervention to manage breast engorgement.

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