Nursing Elites

1. A child newly diagnosed with diabetes mellitus has been stabilized with insulin injections daily. A nurse prepares a discharge teaching plan regarding the insulin. The teaching plan should reinforce which of the following concepts?

• A. Always store insulin vials in the refrigerator
• B. Adjust insulin dosage before exercise
• C. Presence of ketones in urine indicates a need for less insulin
• D. Systematically rotate injection sites

Correct answer: D

Rationale: Systematically rotating injection sites is crucial to prevent tissue damage and ensure optimal insulin absorption. This practice helps in preventing lipohypertrophy, a condition characterized by fat accumulation at injection sites, which can affect insulin absorption and lead to inconsistent blood glucose control. By rotating injection sites, the risk of skin and tissue damage is minimized, and insulin's effectiveness is maintained over time.

2. How should you assist with the delivery of the baby's head?

• A. Grasping each side of the baby's head and gently pulling to facilitate delivery.
• B. Placing your fingers on the bony part of the skull and applying gentle pressure.
• C. Carefully rotating the baby's head to face up during delivery.
• D. Placing the palm of your hand firmly against the back of the baby's skull.

Correct answer: B

Rationale: To assist with the delivery of the baby's head, the correct technique involves placing your fingers on the bony part of the skull and applying gentle pressure. This method helps guide the baby's head through the birth canal safely and effectively. Choices A, C, and D are incorrect. Grasping and pulling the baby's head, rotating the head, or placing the palm of your hand against the back of the baby's skull can potentially cause harm or complications during delivery.

3. What is the MOST appropriate method for assessing a small child's level of responsiveness?

• A. Palpate for a radial pulse.
• B. Shout at the child to see if they respond.
• C. Ask the parent about the child's level of responsiveness.
• D. Tap the child and shout, 'Are you okay?'

Correct answer: D

Rationale: When assessing a small child's level of responsiveness, the most appropriate method is to tap the child and shout, 'Are you okay?' This approach is more likely to elicit a response from the child, providing a direct assessment of their level of consciousness and responsiveness. Palpating for a radial pulse (Choice A) is not the most direct method for assessing responsiveness in a child. Shouting at the child (Choice B) may startle them and not provide an accurate assessment. Asking the parent (Choice C) does not directly evaluate the child's responsiveness.

4. A postpartum client is being discharged and asks the nurse when she should expect her menstrual period to return if she is not breastfeeding. The nurse's best response is:

• A. In about 6 to 8 weeks
• B. In about 3 to 4 months
• C. In about 6 months
• D. In about 1 year

Correct answer: A

Rationale: For non-breastfeeding mothers, the return of menstrual periods typically occurs around 6 to 8 weeks postpartum. This timeframe may vary among individuals, but generally, hormonal changes after childbirth lead to the resumption of menstrual cycles within this period.

5. You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should:

• A. reassess the newborn every 5 minutes and transport after the placenta delivers.
• B. keep the newborn warm, give oxygen to the mother if needed, and transport.
• C. massage the lower part of the mother's uterus until the placenta delivers.
• D. give the newborn high-flow oxygen via a non-rebreathing mask and transport.

Correct answer: B

Rationale: In this scenario, the appropriate action is to keep the newborn warm, ensure the mother receives oxygen if needed, and prepare for transport. The newborn is showing signs of central cyanosis (hands and feet being cyanotic), which can be due to various reasons, including inadequate oxygenation. Therefore, ensuring warmth and possible oxygen to the mother are important. Additionally, monitoring both the mother and baby during transport is crucial for their well-being.

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