Nursing Elites

1. A healthcare provider is assessing a 3-month-old infant with suspected pyloric stenosis. What clinical manifestation is the healthcare provider likely to observe?

• A. Projectile vomiting
• B. Diarrhea
• C. Constipation
• D. Abdominal distension

Correct answer: A

Rationale: Projectile vomiting is a classic clinical manifestation of pyloric stenosis in infants. This occurs due to the narrowing of the pyloric sphincter, leading to the forceful expulsion of gastric contents in a projectile manner. Diarrhea (choice B) is not typically associated with pyloric stenosis. Constipation (choice C) is also not a common symptom of this condition. Abdominal distension (choice D) may occur in pyloric stenosis but is not as specific or characteristic as projectile vomiting in diagnosing this condition.

2. A parent tells the nurse, “My 9-month-old baby no longer has the same strong grasp that was present at birth and no longer acts startled by loud noises.” How should the nurse explain these changes in behavior?

• A. “I will check these responses before deciding how to proceed.”
• B. “Failure of these responses may be related to a developmental delay.”
• C. “Additional sensory stimulation is needed to aid in the return of these responses.”
• D. “These responses are replaced by voluntary activity at about five months of age.”

Correct answer: D

Rationale: The correct answer is D. The grasp reflex and startle reflex (Moro reflex) are normal in newborns but typically disappear as the infant's nervous system matures and voluntary control develops. At around five months of age, these reflexes are replaced by voluntary movements as part of the normal developmental process. Choices A, B, and C are incorrect. Choice A suggests delaying a decision until further assessment, which is not necessary as the disappearance of these reflexes is a normal part of infant development. Choice B implies a developmental delay, which is not the case as these reflexes naturally disappear with age. Choice C recommending additional sensory stimulation is unnecessary and not the reason for the absence of these reflexes.

3. When caring for a child diagnosed with cystic fibrosis, what is the priority nursing intervention?

• A. Administering pancreatic enzymes
• B. Providing respiratory therapy
• C. Encouraging physical activity
• D. Encouraging frequent handwashing

Correct answer: A

Rationale: The priority nursing intervention when caring for a child with cystic fibrosis is administering pancreatic enzymes. Cystic fibrosis is a genetic disorder that affects the digestive and respiratory systems. Administering pancreatic enzymes is crucial in aiding digestion as patients with cystic fibrosis often have pancreatic insufficiency. While providing respiratory therapy and encouraging physical activity are important aspects of care for individuals with cystic fibrosis, administering pancreatic enzymes takes precedence in addressing the malabsorption issues associated with the condition. Encouraging frequent handwashing is also essential in infection control, but it is not the priority intervention specifically related to managing cystic fibrosis.

4. A healthcare professional is assessing a child with suspected rotavirus infection. What clinical manifestation is the healthcare professional likely to observe?

• A. Abdominal pain
• B. Diarrhea
• C. Constipation
• D. Vomiting

Correct answer: B

Rationale: The correct answer is B: Diarrhea. Rotavirus infection commonly presents with symptoms such as watery diarrhea, fever, vomiting, and abdominal pain. However, diarrhea is the hallmark symptom of rotavirus infection, often leading to dehydration in children. Abdominal pain (choice A) can also be present but is not as specific to rotavirus infection as diarrhea. Constipation (choice C) is not a typical symptom of rotavirus infection. While vomiting (choice D) can occur in rotavirus infection, it is more commonly associated with other gastrointestinal conditions.

5. When caring for a 2-year-old girl who is wheezing and has difficulty breathing, which interview question would provide the most useful information related to the symptoms of the child?

• A. Inquiring about child safety in the home
• B. Asking about the temperament of the child
• C. Asking about the child's diet
• D. Asking the parents if they smoke in the home

Correct answer: D

Rationale: Asking the parents if they smoke in the home is the most relevant question as exposure to secondhand smoke can exacerbate respiratory symptoms like wheezing and difficulty breathing in children. Smoking indoors can worsen the child's condition and is crucial information for the healthcare provider to assess and address. Inquiring about child safety in the home, asking about the child's temperament, and questioning the child's diet are important aspects of care but are not directly linked to the immediate respiratory symptoms the child is experiencing.

Similar Questions