Nursing Elites

1. Which information regarding the care of antepartum women with cardiac conditions is most important for the nurse to understand?

• A. Stress on the heart is greatest in the first trimester and the last 2 weeks before labor.
• B. Women with class II cardiac disease should avoid heavy exertion and any activity that causes even minor symptoms.
• C. Women with class III cardiac disease should get 8 to 10 hours of sleep every day and limit housework, shopping, and exercise.
• D. Women with class I cardiac disease need bed rest through most of the pregnancy and face the possibility of hospitalization near term.

Correct answer: B

Rationale: Class II cardiac disease is symptomatic with ordinary activity. Women in this category need to avoid heavy exertion and limit regular activities as symptoms dictate. Stress is greatest between weeks 28 and 32 of gestation, when hemodynamic changes reach their maximum. Class III cardiac disease is symptomatic with less-than-ordinary activity. These women need bed rest most of the day and face the possibility of hospitalization near term. Class I cardiac disease is asymptomatic at normal levels of activity. These women can perform limited normal activities with discretion, although they still need a good amount of sleep.

2. A premature infant with respiratory distress syndrome (RDS) receives artificial surfactant. How does the nurse explain surfactant therapy to the parents?

• A. “Surfactant improves the ability of your baby’s lungs to exchange oxygen and carbon dioxide.”
• B. “The drug keeps your baby from requiring too much sedation.”
• C. “Surfactant is used to reduce episodes of periodic apnea.”
• D. “Your baby needs this medication to fight a possible respiratory tract infection.”

Correct answer: A

Rationale: Artificial surfactant can be administered as an adjunct to oxygen and ventilation therapy for premature infants with respiratory distress syndrome (RDS). It helps improve respiratory compliance by aiding in the exchange of oxygen and carbon dioxide until the infant can produce enough surfactant naturally. The correct explanation to the parents would be that surfactant therapy enhances the baby’s lung function by facilitating the exchange of oxygen and carbon dioxide. Choice B is incorrect because surfactant therapy does not affect sedation needs. Choice C is inaccurate as surfactant is not used to reduce episodes of periodic apnea. Choice D is incorrect as surfactant is not administered to fight respiratory tract infections; it specifically targets improving lung function in RDS.

3. What is the primary rationale for thoroughly drying the infant immediately after birth?

• A. Stimulates crying and lung expansion.
• B. Removes maternal blood from the skin surface.
• C. Reduces heat loss from evaporation.
• D. Increases blood supply to the hands and feet.

Correct answer: C

Rationale: The primary rationale for thoroughly drying the infant immediately after birth is to reduce heat loss from evaporation. This helps maintain the infant's body temperature and prevent hypothermia. Choice A (Stimulates crying and lung expansion) is incorrect because drying the infant is not primarily done to stimulate crying but rather to prevent heat loss. Choice B (Removes maternal blood from the skin surface) is incorrect as the main reason is to prevent heat loss, not to remove maternal blood. Choice D (Increases blood supply to the hands and feet) is also incorrect as drying the infant is not intended to increase blood supply but rather to regulate body temperature.

4. Individuals with Klinefelter syndrome produce:

• A. less estrogen than normal males.
• B. less testosterone than normal males.
• C. less adenine than normal males.
• D. less thymine than normal males.

Correct answer: B

Rationale: Individuals with Klinefelter syndrome have an extra X chromosome (XXY), leading to reduced production of testosterone, the primary male sex hormone. This deficiency can result in various physical and developmental characteristics associated with the syndrome. Estrogen levels may actually be relatively elevated due to the imbalance between testosterone and estrogen. Choices C and D are incorrect as adenine and thymine are nucleotide bases found in DNA and are not related to hormone production.

5. A primiparous woman presents in labor with the following labs: hemoglobin 10.9 g/dL, hematocrit 29%, hepatitis surface antigen positive, Group B Streptococcus positive, and rubella non-immune. Which intervention should the nurse implement?

• A. Transfuse 2 units of packed red blood cells.
• B. Give measles, mumps, rubella vaccine 0.5 mL.
• C. Administer ampicillin 2 grams intravenously.
• D. Inject hepatitis B immune globulin 0.5 milliliters.

Correct answer: C

Rationale: The correct intervention in this scenario is to administer ampicillin 2 grams intravenously. This is crucial to prevent Group B Streptococcus infection in the newborn during delivery. Option A, transfusing packed red blood cells, is not indicated based on the hemoglobin and hematocrit levels provided. Option B, giving measles, mumps, rubella vaccine, is not necessary at this time. Option D, injecting hepatitis B immune globulin, is not appropriate for the conditions presented in the question.

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