Peds/OB
A newborn is 2 hours old. Which assessment finding requires immediate intervention?
Answer:
Central cyanosis.
Rationale
Central cyanosis indicates inadequate oxygenation and is never considered a normal newborn finding. Acrocyanosis (blue hands and feet) is expected during the first 24–48 hours due to immature peripheral circulation.
Which electrolyte imbalance is expected with prolonged vomiting?
Answer
Hypokalemia.
Rationale
Vomiting results in loss of gastric fluids and potassium, increasing the risk for muscle weakness, dysrhythmias, and metabolic alkalosis.
Order: 650 mg
Available: 325-mg tablets
How many tablets?
Answer
2 tablets.
Rationale
650 ÷ 325 = 2 tablets. Always verify calculations before medication administration.
Which patient should the nurse assess first?
A. Pain 8/10
B. Oxygen saturation 86%
C. Nausea
D. Dressing change due
Answer
B.
Rationale
Airway and breathing always take priority. An oxygen saturation of 86% indicates significant hypoxemia requiring immediate assessment.
What is the correct order for donning PPE?
Answer
Gown → Mask/Respirator → Goggles/Face Shield → Gloves.
Rationale
Following the correct sequence minimizes contamination before entering an isolation room.
A 4-year-old with acute otitis media is prescribed amoxicillin. Which statement by the parent indicates understanding?
Answer
"I will make sure my child finishes all of the antibiotic."
Rationale
Completing the full course of antibiotics prevents recurrence and decreases the risk of antibiotic resistance, even if symptoms improve before the medication is finished.
A patient with heart failure develops bilateral crackles and increasing dyspnea. What is the priority nursing intervention?
Answer
Place the patient in High Fowler's position and administer oxygen.
Rationale
High Fowler's position reduces venous return and improves lung expansion. Oxygen helps correct hypoxemia while additional treatments are initiated.
Which medication should the nurse question before administering if the patient's heart rate is 52 bpm?
Answer
Metoprolol.
Rationale
Beta blockers decrease heart rate. Most are held when the heart rate is below 60 beats/min unless otherwise ordered.
Which isolation precautions are required for a client diagnosed with Clostridioides difficile (C. difficile) infection?
A. Airborne precautions with an N95 respirator and alcohol-based hand hygiene
B. Contact precautions with soap-and-water hand hygiene
C. Droplet precautions with a surgical mask and alcohol-based hand hygiene
D. Standard precautions only because antibiotics eliminate the risk of transmission
Correct Answer:
B. Contact precautions with soap-and-water hand hygiene
Rationale:
C. difficile forms spores that are resistant to alcohol-based hand sanitizers. Healthcare providers should use contact precautions, wear gowns and gloves, and wash hands with soap and water after patient contact to effectively remove spores and reduce transmission.
Which isolation precautions are required for Clostridioides difficile?
Answer
Contact precautions with soap-and-water hand hygiene.
Rationale
Alcohol-based hand sanitizer does not effectively kill C. difficile spores; soap and water are required.
A postpartum client has heavy lochia and a firm, midline fundus. What should the nurse suspect?
Answer
Birth canal laceration.
Rationale
Heavy bleeding with a firm uterus suggests trauma rather than uterine atony. Uterine atony typically presents with a boggy uterus.
Which assessment finding suggests worsening infection?
Answer
Hypotension with altered mental status.
Rationale
These findings indicate poor tissue perfusion and possible progression to septic shock, requiring immediate intervention.
Order: 450 mg
Available: 250 mg/5 mL
How many mL?
Answer
9 mL.
Rationale
450250×5=9 mL\frac{450}{250}\times5=9\text{ mL}250450×5=9 mL
Using dimensional analysis helps minimize medication errors.
Which National Patient Safety Goal (NPSG) is specifically designed to help reduce medication administration errors?
A. Perform hourly patient rounding.
B. Encourage patients to keep a list of their medications at home.
C. Use at least two patient identifiers before administering medications.
D. Perform medication reconciliation only at discharge.
Correct Answer:
C. Use at least two patient identifiers before administering medications.
Rationale:
The Joint Commission's National Patient Safety Goals require healthcare providers to verify at least two patient identifiers (such as name and date of birth or medical record number) before administering medications, collecting specimens, or performing procedures. This practice significantly reduces wrong-patient errors.
Which National Patient Safety Goal helps reduce medication errors?
Answer
Use at least two patient identifiers before medication administration.
Rationale
Correct patient identification is one of the Joint Commission's primary strategies to reduce preventable medication errors.
A child with cystic fibrosis has foul-smelling stools despite pancreatic enzyme therapy. What should the nurse teach?
Answer
Administer pancreatic enzymes immediately before every meal and snack.
Rationale
Pancreatic enzymes must mix with food in the intestine to digest fats and proteins. Improper timing leads to steatorrhea, poor weight gain, and malnutrition.
Interpret the following ABG:
Answer
Uncompensated respiratory acidosis.
Rationale
The pH is low (acidosis), PaCO₂ is elevated (respiratory cause), and bicarbonate remains normal, indicating that renal compensation has not yet occurred.
Which laboratory value should be checked before administering digoxin?
Answer
Potassium.
Rationale
Hypokalemia increases the risk for digoxin toxicity because potassium and digoxin compete for receptor sites in the myocardium.
Which patient should the nurse see first?
A. Blood glucose 68
B. Chest tube draining 100 mL/hr
C. New confusion with BP 82/46
D. Temperature 101°F
Answer
C.
Rationale
New hypotension and altered mental status indicate decreased cerebral perfusion and possible shock, making this the highest priority.
Which QSEN competency emphasizes preventing harm to patients?
Answer
Safety.
Rationale
The QSEN Safety competency focuses on minimizing risk of harm through both system effectiveness and individual performance.
A laboring client develops recurrent late decelerations after epidural placement. What interventions should the nurse implement first?
Answer
Left lateral position, increase IV fluids, discontinue oxytocin if infusing, administer oxygen, and notify the provider.
Rationale
Late decelerations indicate uteroplacental insufficiency. These interventions improve placental perfusion and fetal oxygenation while preparing for additional interventions if the pattern persists.
A patient with SIADH suddenly becomes confused and develops muscle twitching. Which electrolyte imbalance is responsible?
Answer
Hyponatremia.
Rationale
Excess ADH causes water retention and dilutional hyponatremia. Severe hyponatremia may progress to seizures and coma.
A child weighs 18 kg.
Order: Ceftriaxone 75 mg/kg/day divided every 12 hours.
How many milligrams per dose?
675 mg per dose.
Rationale
18 kg × 75 mg = 1,350 mg/day. Dividing into two doses equals 675 mg every 12 hours.
A patient suddenly becomes restless, tachypneic, and oxygen saturation drops from 96% to 84%. What is the priority nursing action?
Answer
Assess airway and breathing while administering oxygen and calling for assistance.
Rationale
Restlessness is often an early sign of hypoxia. Immediate assessment and oxygen administration follow the ABC priority framework.
The nurse discovers a medication error occurred but the patient was not harmed. What is the nurse's priority action?
Answer
Assess the patient first, notify the provider as appropriate, complete an incident report, and document objectively.
Rationale
Patient safety always comes before reporting. Incident reports are used for quality improvement and should never be referenced in the medical record.