Nursing Elites

1. A child with a diagnosis of pyloric stenosis is scheduled for surgery. What preoperative intervention is important for the nurse to perform?

• A. Administering intravenous fluids
• B. Monitoring for signs of infection
• C. Monitoring for signs of dehydration
• D. Monitoring for signs of pain

Correct answer: C

Rationale: The correct preoperative intervention for a child with pyloric stenosis is to monitor for signs of dehydration. Pyloric stenosis can lead to vomiting, which can result in dehydration. Monitoring for signs of dehydration is crucial to ensure the child's fluid balance is maintained. Administering intravenous fluids, although important for managing dehydration and electrolyte imbalances, would typically be done postoperatively rather than as a preoperative intervention. Monitoring for signs of infection is important but not specific to the preoperative period for pyloric stenosis. Monitoring for signs of pain is also important but may not be the most critical preoperative intervention in this scenario.

2. A group of students is reviewing information about the endocrine system in infants and children. The students demonstrate understanding of the information when they state:

• A. Endocrine glands begin developing during gestation.
• B. Endocrine glands are fully functional at birth.
• C. Infants may have difficulty regulating glucose and electrolytes.
• D. A child’s endocrine system plays a significant role in growth and development.

Correct answer: C

Rationale: The correct answer is C. Infants may have difficulty regulating glucose and electrolytes due to their immature endocrine systems. This can lead to issues such as hypoglycemia and electrolyte imbalances. Choice A is incorrect because endocrine glands actually begin developing early in gestation, not just in the third trimester. Choice B is incorrect as endocrine glands are not fully functional at birth; they continue to mature and develop after birth. Choice D is incorrect as a child's endocrine system has a significant impact on growth and development through the secretion of hormones that regulate various processes in the body, but it does not specifically address the difficulty in regulating glucose and electrolytes seen in infants.

3. The caregiver is teaching the mother of a toddler about burn prevention. Which response by the mother indicates a need for further teaching?

• A. We will leave fireworks displays to the professionals.
• B. I will set our water heater at 130 degrees.
• C. All sleepwear should be flame retardant.
• D. The handles of pots on the stove should face inward.

Correct answer: B

Rationale: Setting the water heater at 130 degrees can lead to scald burns. The recommended temperature setting for water heaters is no higher than 120 degrees to prevent burns. Choice A is correct as it shows awareness of the risks of fireworks. Choice C is correct as flame-retardant sleepwear can help prevent burns. Choice D is correct as inward-facing pot handles prevent accidental spills and burns. Option B is incorrect due to the unsafe water heater temperature setting.

4. The nurse is caring for a child and family who just moved out of a dangerous neighborhood. Which of the following approaches is appropriate based on the family stress theory?

• A. Determining who the decision-maker is
• B. Assessing the child's coping abilities
• C. Exploring how a sibling feels
• D. Explaining procedures to a sibling

Correct answer: B

Rationale: Assessing the child's coping abilities is appropriate based on the family stress theory because it helps the nurse understand how well the child can manage and adapt to the stressors related to the move. This assessment can guide interventions to support the child's emotional well-being and adjustment. Choices A, C, and D are not directly related to assessing the child's coping abilities and may not address the child's immediate needs during this stressful time.

5. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. The woman states that her contractions are occurring every 4 to 5 minutes and lasting approximately 30 seconds each. Which of the following questions would be most appropriate to ask at this point?

• A. Has your bag of waters broken yet?
• B. Have you had regular prenatal care?
• C. At how many weeks gestation are you?
• D. How many other children do you have?

Correct answer: C

Rationale: Asking about the gestational age is crucial in determining the stage of labor and assessing potential complications. This information helps in understanding the progress of labor and making appropriate decisions regarding the management of the delivery process. Choices A, B, and D are not as pertinent at this point in providing immediate care or assessing the situation compared to knowing the gestational age.

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