Nursing Elites

1. A child with type 1 diabetes mellitus is being discharged from the hospital. What is important for the nurse to include in the discharge teaching?

• A. Monitor blood glucose levels once a day
• B. Follow a strict meal plan
• C. Administer insulin only when blood glucose is high
• D. Recognize signs of hypoglycemia

Correct answer: D

Rationale: Recognizing signs of hypoglycemia is essential for managing type 1 diabetes mellitus. Hypoglycemia, which occurs when blood glucose levels drop too low, can be dangerous and requires immediate intervention to prevent severe complications. Monitoring blood glucose levels more frequently than once a day, following a strict meal plan, and administering insulin only when blood glucose is high are important aspects of diabetes management but recognizing signs of hypoglycemia is crucial as it enables prompt action to prevent adverse outcomes.

2. Why does a cleft lip predispose an infant to infection, concerning a nurse caring for the infant?

• A. Waste products accumulate along the defect.
• B. There is inadequate circulation in the defective area.
• C. Nutrition is inadequate due to ineffective feeding.
• D. Mouth breathing dries the oropharyngeal mucous membranes.

Correct answer: D

Rationale: Mouth breathing due to a cleft lip can dry the mucous membranes, increasing their susceptibility to infection. While waste product accumulation (Choice A) and inadequate circulation (Choice B) may contribute to complications, they are not directly related to infection in this context. Inadequate nutrition (Choice C) may affect overall health but is not the primary reason for infection predisposition in this case.

3. A home care nurse is visiting a family for the first time. The 4-week-old infant had surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired, and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

• A. “Tell me about your daily routine.”
• B. “You look tired. Is everything alright?”
• C. “When was the last time the baby had a bottle?”
• D. “Oh, it looks like you two are having a bad day.”

Correct answer: A

Rationale: Asking about the daily routine is the most appropriate statement by the nurse in this scenario. It allows the nurse to gather important information about the family's schedule, feeding patterns, and overall care routine for the infant. This open-ended question helps the nurse assess the family's situation comprehensively and identify any areas where support may be needed. Choices B, C, and D are less appropriate as they do not focus on gathering relevant information about the family's routine and needs but rather make assumptions or ask about specific isolated events.

4. When explaining a viral disease that begins with malaise and a highly pruritic rash starting on the abdomen, spreading to the face and proximal extremities, and potentially leading to severe complications, which childhood disease is a nurse discussing with members of a grammar school’s Parent-Teachers Association?

• A. Rubella
• B. Rubeola
• C. Chickenpox
• D. Scarlet fever

Correct answer: C

Rationale: The correct answer is Chickenpox (varicella). This viral disease typically starts with malaise and a highly pruritic rash that begins on the abdomen and then spreads to the face and proximal extremities. Chickenpox can result in serious complications such as pneumonia and encephalitis. Rubella (German measles) presents with a milder rash and is less pruritic than chickenpox. Rubeola (measles) is characterized by a rash that spreads from the head to the trunk. Scarlet fever is caused by group A Streptococcus bacteria and is not a viral illness.

5. What information should be included in the preoperative plan of care for an infant with myelomeningocele?

• A. Positioning the infant supine with a pillow under the buttocks
• B. Covering the sac with saline-soaked nonadhesive gauze
• C. Wrapping the infant snugly in a blanket
• D. Applying a diaper to prevent fecal soiling of the sac

Correct answer: B

Rationale: Covering the sac with saline-soaked nonadhesive gauze is essential in the preoperative care of an infant with myelomeningocele. This practice helps prevent infection and maintains moisture around the sac before surgery, promoting optimal healing outcomes. Positioning the infant supine with a pillow under the buttocks may be uncomfortable and unnecessary. Wrapping the infant snugly in a blanket does not address the specific care needs of the myelomeningocele. Applying a diaper over the sac can increase the risk of infection and should be avoided in this case.

Similar Questions