Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is reviewing the laboratory report for a client who is in active labor. The client tested positive for group B streptococcus B-hemolytic. Which of the following medications should the nurse plan to administer to the client?
A. Doxycycline.
Rationale against: Poor penetration into amniotic fluid:Doxycycline does not effectively reach the amniotic sac,where the baby is surrounded,and therefore may not adequately protect the newborn from GBS infection. Adverse effects in newborns:Doxycycline can cause tooth discoloration and bone development problems in infants exposed in utero.
B. Cefotetan.
Rationale for: Alternative for penicillin allergy:Cefotetan is a cephalosporin antibiotic effective against GBS and can be used in women with penicillin allergy. Rationale against: Second-line option:Ampicillin is the preferred choice due to its lower cost and broader spectrum of activity against GBS strains.
C. Ampicillin.
Rationale: Group B Streptococcus (GBS) B-hemolyticis a bacterium that can colonize the vagina and rectum of pregnant women.While usually harmless to the mother,it can be passed to the newborn during birth and cause serious infections,including pneumonia,meningitis,and sepsis. Ampicillinis thefirst-line antibioticrecommended by the Centers for Disease Control and Prevention (CDC) for theprevention of GBS disease in newborns.It belongs to thepenicillin classof antibiotics,which are highly effective against GBS and generally well-tolerated by pregnant women and newborns. Rationale for: First-line antibiotic:Ampicillin is the CDC-recommended first-line antibiotic for GBS prophylaxis due to its: High effectiveness against GBS:Ampicillin has a broad spectrum of activity against GBS strains. Good safety profile:Ampicillin is generally well-tolerated by pregnant women and newborns. Cost-effectiveness:Ampicillin is a relatively inexpensive antibiotic compared to other options. Doxycyclineis not recommended for GBS prophylaxis due to its poor penetration into amniotic fluid and potential for causing tooth discoloration and bone development problems in newborns. Cefotetanis an alternative option for women with penicillin allergy,but ampicillin is still preferred due to its lower cost and broader spectrum of activity against GBS strains. Fluconazoleis an antifungal medication and has no activity against GBS bacteria.
D. Fluconazole.
Rationale against: Antifungal medication:Fluconazole is an antifungal medication and has no activity against GBS,which is a bacterium.
This question is an excerpt from Nurse Dive's nursing test bank - ATI Maternal Newborn 2019 NGN Proctored Exam. Take the full exam now
Full Explanation
The correct answer is c. Ampicillin.
Rationale:
- Group B Streptococcus (GBS) B-hemolytic is a bacterium that can colonize the vagina and rectum of pregnant women. While usually harmless to the mother, it can be passed to the newborn during birth and cause serious infections, including pneumonia, meningitis, and sepsis.
- Ampicillin is the first-line antibiotic recommended by the Centers for Disease Control and Prevention (CDC) for the prevention of GBS disease in newborns. It belongs to the penicillin class of antibiotics, which are highly effective against GBS and generally well-tolerated by pregnant women and newborns.
- Doxycycline is not recommended for GBS prophylaxis due to its poor penetration into amniotic fluid and potential for causing tooth discoloration and bone development problems in newborns.
- Cefotetan is an alternative option for women with penicillin allergy, but ampicillin is still preferred due to its lower cost and broader spectrum of activity against GBS strains.
- Fluconazole is an antifungal medication and has no activity against GBS bacteria.
Detailed Rationale for Each Choice:
a. Doxycycline:
- Rationale against:
- Poor penetration into amniotic fluid: Doxycycline does not effectively reach the amniotic sac, where the baby is surrounded, and therefore may not adequately protect the newborn from GBS infection.
- Adverse effects in newborns: Doxycycline can cause tooth discoloration and bone development problems in infants exposed in utero.
b. Cefotetan:
- Rationale for:
- Alternative for penicillin allergy: Cefotetan is a cephalosporin antibiotic effective against GBS and can be used in women with penicillin allergy.
- Rationale against:
- Second-line option: Ampicillin is the preferred choice due to its lower cost and broader spectrum of activity against GBS strains.
c. Ampicillin:
- Rationale for:
- First-line antibiotic: Ampicillin is the CDC-recommended first-line antibiotic for GBS prophylaxis due to its:
- High effectiveness against GBS: Ampicillin has a broad spectrum of activity against GBS strains.
- Good safety profile: Ampicillin is generally well-tolerated by pregnant women and newborns.
- Cost-effectiveness: Ampicillin is a relatively inexpensive antibiotic compared to other options.
- First-line antibiotic: Ampicillin is the CDC-recommended first-line antibiotic for GBS prophylaxis due to its:
d. Fluconazole:
- Rationale against:
- Antifungal medication: Fluconazole is an antifungal medication and has no activity against GBS, which is a bacterium.
Similar Questions
A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following actions should the nurse take?
A. Swaddle the newborn with his legs extended.
Swaddling the newborn with his legs extended is not the appropriate action for a newborn with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on drugs, usually because the mother used opioids during pregnancy. Swaddling may provide some comfort, but extending the legs could increase discomfort and agitation.
B. Schedule larger volume feedings at less frequent intervals.
Scheduling larger volume feedings at less frequent intervals is not the correct approach for a newborn with NAS. These infants often have feeding difficulties and may require smaller, more frequent feedings to reduce the risk of aspiration.
C. Maintain eye contact with the newborn during feedings.
Maintaining eye contact with the newborn during feedings may not be well-tolerated by a baby with NAS. They can be irritable and easily overstimulated, and eye contact during feeding may exacerbate their agitation.
D. Plan care to minimize handling of the newborn.
Planning care to minimize handling of the newborn is the most appropriate action for a baby with NAS. These infants are sensitive to stimuli and can become agitated easily, so minimizing unnecessary handling helps reduce their distress.
Full Explanation
Choice A rationale:
Swaddling the newborn with his legs extended is not the appropriate action for a newborn with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on drugs, usually because the mother used opioids during pregnancy. Swaddling may provide some comfort, but extending the legs could increase discomfort and agitation.
Choice B rationale:
Scheduling larger volume feedings at less frequent intervals is not the correct approach for a newborn with NAS. These infants often have feeding difficulties and may require smaller, more frequent feedings to reduce the risk of aspiration.
Choice C rationale:
Maintaining eye contact with the newborn during feedings may not be well-tolerated by a baby with NAS. They can be irritable and easily overstimulated, and eye contact during feeding may exacerbate their agitation.
Choice D rationale:
Planning care to minimize handling of the newborn is the most appropriate action for a baby with NAS. These infants are sensitive to stimuli and can become agitated easily, so minimizing unnecessary handling helps reduce their distress.
The correct answer is D. Plan care to minimize handling of the newborn.
Here's why:
- Swaddling with legs extended: This is not recommended as it can be uncomfortable for the newborn and may exacerbate withdrawal symptoms.
- Larger volume feedings at less frequent intervals: This can be difficult for newborns with NAS due to their increased metabolic rate and may lead to overfeeding.
- Maintaining eye contact during feedings: While this is important for bonding, it can be overwhelming for newborns with NAS, who often prefer a calm environment.
Minimizing handling is a key intervention in caring for newborns with NAS. Excessive handling can trigger withdrawal symptoms and make the newborn more irritable. Instead, focus on gentle, soothing techniques like swaddling with arms tucked in, rocking, and providing a quiet, dimly lit environment.
A nurse is teaching a newly hired nurse about Apgar scoring. Which of the following statements by the newly hired nurse indicates an understanding of the teaching?
A. "The nurse should determine the Apgar score at 2 and 7 minutes after birth.”.
The Apgar score is determined at 1 and 5 minutes after birth, not at 2 and 7 minutes.
B. "The nurse should identify that the newborn is in severe distress with an Apgar score of 8.”.
An Apgar score of 8 indicates that the newborn is in good health, not severe distress. Scores of 7-10 are considered normal.
C. "The nurse should wait for the first Apgar score before initiating resuscitation efforts.”.
Resuscitation efforts should not be delayed until the first Apgar score is obtained. Immediate resuscitation is initiated if needed, regardless of the Apgar score.
D. "The nurse should measure the newborn's muscle tone when assigning an Apgar score.".
Muscle tone is one of the five criteria assessed in the Apgar score, along with appearance, pulse, grimace, and respiration.
Full Explanation
The correct answer is choice d. “The nurse should measure the newborn’s muscle tone when assigning an Apgar score.”
Choice A rationale:
The Apgar score is determined at 1 and 5 minutes after birth, not at 2 and 7 minutes.
Choice B rationale:
An Apgar score of 8 indicates that the newborn is in good health, not severe distress. Scores of 7-10 are considered normal.
Choice C rationale:
Resuscitation efforts should not be delayed until the first Apgar score is obtained. Immediate resuscitation is initiated if needed, regardless of the Apgar score.
Choice D rationale:
Muscle tone is one of the five criteria assessed in the Apgar score, along with appearance, pulse, grimace, and respiration.
A nurse is caring for a client who is 12 hr postpartum and has a fourth-degree laceration of the perineum. Which of the following actions should the nurse take?
A. Provide the client with a cool sitz bath.
A cool sitz bath can help reduce swelling and provide pain relief for a client with a fourth-degree laceration of the perineum. Cooling the area can also help minimize inflammation and promote healing.
B. Administer methylergonovine 0.2 mg IM.
Methylergonovine is typically used to prevent or treat postpartum hemorrhage by causing uterine contractions. It is not indicated for the management of perineal lacerations.
C. Apply a moist, warm compress to the perineum.
Applying a moist, warm compress to the perineum is not recommended immediately postpartum for a fourth-degree laceration, as it can increase swelling and discomfort. Cool treatments are preferred initially.
D. Apply povidone-iodine to the client's perineum after she voids.
Applying povidone-iodine to the perineum is not a standard practice for managing perineal lacerations. It can cause irritation and is not necessary for wound care in this context.
Full Explanation
The correct answer is choice a. Provide the client with a cool sitz bath.
Choice A rationale:
A cool sitz bath can help reduce swelling and provide pain relief for a client with a fourth-degree laceration of the perineum. Cooling the area can also help minimize inflammation and promote healing.
Choice B rationale:
Methylergonovine is typically used to prevent or treat postpartum hemorrhage by causing uterine contractions. It is not indicated for the management of perineal lacerations.
Choice C rationale:
Applying a moist, warm compress to the perineum is not recommended immediately postpartum for a fourth-degree laceration, as it can increase swelling and discomfort. Cool treatments are preferred initially.
Choice D rationale:
Applying povidone-iodine to the perineum is not a standard practice for managing perineal lacerations. It can cause irritation and is not necessary for wound care in this context.