Nursing Elites

1. Why might a healthcare provider question a health care provider's order for a tap water enema for a 6-month-old infant with suspected Hirschsprung disease?

• A. The result could lead to loss of necessary nutrients.
• B. It could cause a fluid and electrolyte imbalance.
• C. It could increase the fear of intrusive procedures.
• D. The result could cause shock from a sudden drop in temperature.

Correct answer: B

Rationale: The correct answer is B. Tap water enemas can cause significant fluid and electrolyte imbalances, particularly in infants, making them unsafe for this age group. Choice A is incorrect because tap water enemas are unlikely to lead to loss of necessary nutrients. Choice C is incorrect as it does not directly relate to the physiological risk of tap water enemas. Choice D is incorrect as shock from a sudden drop in temperature is not a common concern with tap water enemas.

2. Which of the following statements regarding 2-rescuer child CPR is correct?

• A. The chest should not be allowed to fully recoil in between compressions as this may impede venous return.
• B. Compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest.
• C. The chest should be compressed with one hand and a compression to ventilation ratio of 30:2 should be delivered.
• D. A compression to ventilation ratio of 15:2 should be delivered without pauses in compressions to deliver ventilations.

Correct answer: B

Rationale: The correct statement regarding 2-rescuer child CPR is to compress the chest with one or two hands to a depth equal to one-half to one third the diameter of the chest. This technique ensures effective chest compressions without causing excessive damage to the chest. Choice A is incorrect because allowing the chest to fully recoil between compressions is essential to facilitate optimal blood flow during CPR. Choice C is incorrect as it describes a compression to ventilation ratio of 30:2, which is not the recommended ratio for child CPR. Choice D is incorrect as a compression to ventilation ratio of 15:2 is not standard practice for child CPR, and pauses in compressions are necessary to provide ventilations effectively.

3. When teaching a class of new parents about positioning their infants during the first few weeks of life, which position is safest?

• A. On the back, lying flat
• B. On either side, lying flat
• C. Head slightly elevated on the left side
• D. Head slightly elevated on the right side

Correct answer: A

Rationale: The correct answer is A: 'On the back, lying flat'. Placing infants on their back to sleep is recommended to reduce the risk of sudden infant death syndrome (SIDS). This position helps ensure the baby's airway remains clear and reduces the likelihood of suffocation. Choices B, C, and D are not as safe as placing the infant on their back, as they may increase the risk of accidental suffocation or SIDS.

4. A child with a cardiac malformation associated with left-to-right shunting. What does this type of congenital disorder lead to primarily?

• A. Elevated hematocrit
• B. Severe growth retardation
• C. Clubbing of the fingers and toes
• D. Increased blood flow to the lungs

Correct answer: D

Rationale: Left-to-right shunting in a cardiac malformation results in increased blood flow to the lungs. This increased blood flow can lead to pulmonary hypertension and heart failure if left untreated. Elevated hematocrit (Choice A) is not a characteristic directly associated with left-to-right shunting. Severe growth retardation (Choice B) is not a typical manifestation of this type of congenital disorder. Clubbing of the fingers and toes (Choice C) is more commonly seen in conditions like chronic respiratory or cardiac diseases, not specifically with left-to-right shunting and associated cardiac malformations.

5. The nurse is caring for a 1-month-old girl with low-set ears and severe hypotonia who was diagnosed with trisomy 18. Which nursing diagnosis would the nurse identify as most likely?

• A. Interrupted family process related to the child's diagnosis
• B. Deficient knowledge related to the genetic disorder
• C. Grieving related to the child's poor prognosis
• D. Ineffective coping related to stress from providing care

Correct answer: C

Rationale: The correct nursing diagnosis would be 'Grieving related to the child's poor prognosis.' Trisomy 18 is associated with a poor prognosis, and families often experience feelings of grief and loss when dealing with such a diagnosis. The choice 'Interrupted family process' does not directly address the emotional response to the prognosis. 'Deficient knowledge' may be a concern but does not address the emotional aspect of dealing with a poor prognosis. 'Ineffective coping related to stress from providing care' focuses more on the caregiver's ability to cope rather than the family's response to the child's condition.

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