Nursing Elites

1. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after birth. What should the nurse consider before responding?

• A. Feeding problems are common in neonates.
• B. Inadequate sucking is not significant in the absence of cyanosis.
• C. Ineffective sucking and swallowing may be early indications of a heart defect.
• D. Many neonates retain mucus, which may interfere with feeding for several weeks.

Correct answer: C

Rationale: In this scenario, the nurse should consider that ineffective sucking and swallowing in a 2-week-old infant could be early signs of a heart defect such as a ventricular septal defect. This is crucial information as it can guide further assessment and management. Choice A is incorrect because while feeding problems can be common in neonates, in this case, the specific context of a suspected heart defect should be prioritized. Choice B is incorrect as inadequate sucking can indeed be significant, especially when considering potential underlying heart issues, regardless of the presence of cyanosis. Choice D is incorrect as while mucus retention can affect feeding, in this case, the focus should be on the possibility of a heart defect rather than a temporary issue like mucus interference.

2. A healthcare provider is assessing a 3-month-old infant with suspected pyloric stenosis. What clinical manifestation is the healthcare provider likely to observe?

• A. Projectile vomiting
• B. Diarrhea
• C. Constipation
• D. Abdominal distension

Correct answer: A

Rationale: Projectile vomiting is a classic clinical manifestation of pyloric stenosis in infants. This occurs due to the narrowing of the pyloric sphincter, leading to the forceful expulsion of gastric contents in a projectile manner. Diarrhea (choice B) is not typically associated with pyloric stenosis. Constipation (choice C) is also not a common symptom of this condition. Abdominal distension (choice D) may occur in pyloric stenosis but is not as specific or characteristic as projectile vomiting in diagnosing this condition.

3. During a routine monthly examination, a 5-month-old infant is brought to the pediatric clinic. What assessment finding should alert the nurse to notify the health care provider?

• A. Temperature of 99.5°F
• B. Blood pressure of 75/48 mm Hg
• C. Heart rate of 100 beats per minute
• D. Respiratory rate of 50 breaths per minute

Correct answer: D

Rationale: A respiratory rate of 50 breaths per minute in a 5-month-old infant is considered high and may indicate respiratory distress. Infants normally have a higher respiratory rate than older children and adults, but a rate of 50 breaths per minute is above the expected range. This finding warrants immediate attention as it may be indicative of an underlying respiratory issue or distress. Choice A (Temperature of 99.5°F) is within the normal range for body temperature and does not necessarily indicate a critical issue. Choice B (Blood pressure of 75/48 mm Hg) is not typically assessed in isolation for a 5-month-old infant during a routine examination, and the values provided are not indicative of a critical condition. Choice C (Heart rate of 100 beats per minute) is within the normal range for heart rate in infants and may not be a cause for immediate concern during a routine examination.

4. A nurse is inspecting the skin of a child with atopic dermatitis. What would the nurse expect to observe?

• A. Erythematous papulovesicular rash
• B. Dry, red, scaly rash with lichenification
• C. Pustular vesicles with honey-colored exudates
• D. Hypopigmented oval scaly lesions

Correct answer: B

Rationale: In atopic dermatitis, the characteristic presentation includes a dry, red, scaly rash with lichenification. This appearance is due to chronic inflammation and scratching. Choice A is incorrect as erythematous papulovesicular rash is more indicative of conditions like contact dermatitis. Choice C is incorrect as pustular vesicles with honey-colored exudates are seen in impetigo. Choice D is incorrect as hypopigmented oval scaly lesions are more characteristic of tinea versicolor.

5. When caring for a neonate with a suspected tracheoesophageal fistula, what nursing care should be included?

• A. Elevating the head but giving nothing by mouth
• B. Elevating the head for feedings
• C. Feeding glucose water only
• D. Avoiding suctioning unless the infant is cyanotic

Correct answer: A

Rationale: In a neonate with a suspected tracheoesophageal fistula, elevating the head but giving nothing by mouth is crucial to prevent aspiration. Placing the neonate in a semi-upright position helps reduce the risk of reflux and aspiration of gastric contents into the lungs. Elevating the head for feedings (Choice B) would still pose a risk of aspiration as the neonate may aspirate during feeding. Feeding glucose water only (Choice C) is not appropriate and does not address the risk of aspiration associated with a tracheoesophageal fistula. Avoiding suctioning unless the infant is cyanotic (Choice D) is incorrect because suctioning may be necessary for maintaining airway patency, regardless of cyanosis, in a neonate with a suspected tracheoesophageal fistula.

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