Nursing Elites

1. A 6-year-old male is hospitalized in stable condition with multiple fractures following a car accident. The child's parents tell the nurse that their 7-year-old daughter is very upset about the accident and is concerned that her brother will die. Which suggestion by the nurse is most appropriate?

• A. Encourage the parents to phone the sister frequently with updates on her brother's condition.
• B. Suggest that the sister come to the hospital for a visit.
• C. Suggest that one parent leave the hospital to spend extra time with their daughter at home.
• D. Remind the parents that it is normal for children to be upset when their sibling is hospitalized.

Correct answer: B

Rationale: In situations where a sibling is upset about a family member being hospitalized, suggesting that the sister come to the hospital for a visit can help alleviate her concerns. This allows the sister to see her brother, ask questions, and receive reassurance from seeing him in stable condition. Direct contact and interaction can often provide more comfort and understanding than phone calls or staying at home. Encouraging phone calls (Choice A) might not provide the same level of comfort as a physical visit. While spending extra time with the daughter at home (Choice C) is important, in this scenario, facilitating a visit to the hospital can address the daughter's immediate concerns better. Reminding the parents that it is normal for children to be upset (Choice D) is not as proactive as arranging for the sister to visit her brother.

2. Which of the following is MOST likely to occur in conjunction with a breech presentation?

• A. Vertex presentation
• B. Maternal hypertension
• C. Prolapsed umbilical cord
• D. Premature rupture of the amniotic sac

Correct answer: C

Rationale: In a breech presentation, where the baby's buttocks or feet present first, there is an increased risk of the umbilical cord slipping down alongside or below the presenting part, leading to a prolapsed umbilical cord. This is a serious complication that can compromise fetal blood flow and oxygenation, necessitating prompt intervention to prevent adverse outcomes. Choices A, B, and D are less likely to occur in conjunction with a breech presentation. Vertex presentation is the normal head-first presentation, maternal hypertension is a separate condition that may not be directly related to fetal presentation, and premature rupture of the amniotic sac can happen independently of the baby's presentation.

3. Serwaa, a 26-year-old mother, has brought her daughter to the OPD with signs of lower respiratory tract infection. Which of the following diagnoses is NOT typically associated with lower respiratory tract infections for her daughter?

• A. Pneumonia
• B. Asthma
• C. Bronchiolitis
• D. Coryza

Correct answer: D

Rationale: Coryza, also known as the common cold, is a viral infection that primarily affects the upper respiratory tract and is not typically associated with lower respiratory tract infections. Pneumonia, asthma, and bronchiolitis are conditions that commonly affect the lower respiratory tract, causing symptoms like cough, difficulty breathing, and chest pain.

4. You have arrived for your shift on the children's ward and need to assess a 2-year-old who is accompanied by his father. Identify the appropriate strategy to successfully complete a focused assessment:

• A. Allow the child to inspect the equipment for faults before and during assessment
• B. Ask parent to leave room until assessment has been completed
• C. Perform traumatic or invasive procedures first
• D. Have the child sit in parents lap and request assistance if necessary

Correct answer: D

Rationale: Having the child sit in parent's lap can help reduce anxiety and allow for a more accurate assessment.

5. What action should you take if a newborn's heart rate is 50 beats/min?

• A. Begin chest compressions.
• B. Reassess in 30 seconds.
• C. Administer blow-by oxygen.
• D. Start positive-pressure ventilations.

Correct answer: D

Rationale: If a newborn's heart rate is below 60 beats per minute, the appropriate action is to start positive-pressure ventilations. Ventilations help deliver oxygen to the newborn's body and support respiratory function, which is critical in cases of bradycardia. Chest compressions are not recommended until the heart rate is below 60 despite adequate ventilation. Reassessment is essential but not the immediate action required in this scenario. Administering blow-by oxygen alone may not effectively address the underlying cause of bradycardia, making positive-pressure ventilations the priority intervention in this case.

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