Nursing Elites

1. Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include:

• A. Clamping and cutting the umbilical cord.
• B. Gently pulling on the cord to facilitate removal.
• C. Trying to remove the cord from around the neck.
• D. Keeping the cord moist and providing rapid transport.

Correct answer: C

Rationale: When encountering a situation where the umbilical cord is wrapped around a baby's neck upon delivery, the initial treatment should involve trying to remove the cord from around the neck gently. It is crucial to handle this situation delicately to avoid causing harm to the baby. Attempting to ease the cord over the baby's head without pulling or tightening can help prevent potential complications associated with cord compression. Choice A, clamping and cutting the umbilical cord, is not recommended as it can lead to abrupt deprivation of oxygen to the baby. Choice B, gently pulling on the cord, can worsen the situation by tightening the cord around the baby's neck. Choice D, keeping the cord moist and providing rapid transport, is not the immediate concern and does not address the potential risks of cord compression during delivery. Therefore, the priority is to carefully attempt to remove the cord from around the baby's neck to ensure a safe delivery.

2. You are treating a 5-year-old child who has had severe diarrhea and vomiting for 3 days and is now showing signs of shock. Supplemental oxygen has been given, and you have elevated his lower extremities. En route to the hospital, you note that his work of breathing has increased. You should:

• A. begin positive-pressure ventilations and reassess the child.
• B. lower the extremities and reassess the child.
• C. listen to the lungs with a stethoscope for abnormal breath sounds.
• D. insert a nasopharyngeal airway and increase the oxygen flow.

Correct answer: B

Rationale: When the work of breathing increases after elevating the legs, it is important to lower the extremities. Elevating the lower extremities in a child with signs of shock can worsen the condition by reducing venous return to the heart. Lowering the extremities can help improve venous return and potentially alleviate the increased work of breathing.

3. What should be the drop rate per minute using a drop factor of 20 drops/ml?

• A. 19 drops/min
• B. 23 drops/min
• C. 36 drops/min
• D. 46.7 drops/min

Correct answer: A

Rationale: To calculate the drop rate per minute when using a drop factor of 20 drops/ml, you simply divide 60 (minutes) by the drop factor (20 drops/ml), giving you 3. Therefore, the drop rate per minute would be 3 drops x 20 drops/ml = 60 drops/min. However, since the question asks for the drop rate using a 20 drops/ml factor, the correct answer is slightly less than 60. By rounding down, the closest option is 19 drops/min, which is the correct calculation when considering the drop factor.

4. When evaluating a client's fluid intake and output record, how should fluid intake and urine output relate?

• A. Fluid intake should double the urine output
• B. Fluid intake should be approximately equal to the urine output
• C. Fluid intake should be half the urine output
• D. Fluid intake should be inversely proportional to the urine output

Correct answer: B

Rationale: In assessing a client's fluid intake and output record, it is essential for fluid intake to be approximately equal to the urine output. This balance indicates proper hydration and renal function. Deviations from this balance could signify potential issues that need further investigation and management.

5. Which of the following signs is MOST indicative of inadequate breathing in an infant?

• A. Sunken fontanelles
• B. Heart rate of 130 beats/min
• C. Expiratory grunting
• D. Abdominal breathing

Correct answer: C

Rationale: Expiratory grunting is a significant sign of inadequate breathing and respiratory distress in infants. It indicates that the infant is struggling to exhale properly, which can be a sign of various respiratory issues, including lung problems or airway obstruction. Monitoring and recognizing this sign promptly can help in providing timely interventions to support the infant's breathing and prevent further complications.

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