Nursing Elites

1. A nurse is caring for an infant with intractable vomiting. For what complication is it most important for the nurse to assess?

• A. Acidosis
• B. Alkalosis
• C. Hyperkalemia
• D. Hypernatremia

Correct answer: B

Rationale: When an infant experiences intractable vomiting, it can lead to the loss of stomach acids, resulting in metabolic alkalosis. Alkalosis is characterized by elevated blood pH and can lead to serious complications. Assessing for alkalosis is essential in this scenario to monitor and manage the infant's condition. Choices A, C, and D are incorrect because in this context, the primary concern is the metabolic imbalance caused by excessive vomiting, leading to alkalosis rather than acidosis, hyperkalemia, or hypernatremia.

2. A parent calls the outpatient clinic requesting information about the appropriate dose of acetaminophen for a 16-month-old child who has signs of an upper respiratory tract infection and fever. The directions on the bottle of acetaminophen elixir are 120 mg every 4 hours when needed. At the toddler’s 15-month visit, the healthcare provider prescribed 150 mg. What is the nurse’s best response to the parent?

• A. “The dose is close enough, and it doesn’t really matter which one is given.”
• B. “From your description, the medication is not necessary. It should be avoided at this age.”
• C. “It is appropriate to use dosages based on age. Children typically have weights consistent for their age groups.”
• D. “The prescribed dose of the drug was based on weight, and this is a more accurate way of determining a therapeutic dose.”

Correct answer: D

Rationale: The most accurate way to determine a therapeutic dose for children is based on their weight rather than age. Weight-based dosing accounts for individual variations in drug metabolism and distribution, ensuring a more precise and safer medication administration. Choices A, B, and C are incorrect as they do not address the importance of weight-based dosing in children, potentially leading to inappropriate dosing and safety concerns.

3. The caregiver is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the caregiver indicates a need for further teaching?

• A. I need to avoid pushing or pulling on an arm or leg.
• B. I should carefully lift the baby by supporting the head and neck.
• C. I should not bend an arm or leg into an awkward position.
• D. We must avoid lifting the legs by the ankles to change diapers.

Correct answer: B

Rationale: Lifting the baby by supporting the head and neck can cause fractures in infants with osteogenesis imperfecta. Caregivers should avoid lifting infants in this manner due to the risk of injury. Choices A, C, and D demonstrate correct understanding of how to prevent injuries in infants with osteogenesis imperfecta by avoiding excessive force on the arms or legs, preventing awkward positions, and lifting the legs in a safer manner to change diapers.

4. What is an essential nursing action when caring for a young child with severe diarrhea?

• A. Maintain the IV.
• B. Take daily weights.
• C. Replace the lost calories.
• D. Promote perianal skin integrity.

Correct answer: D

Rationale: Promoting perianal skin integrity is crucial when caring for a young child with severe diarrhea as it helps prevent skin breakdown from the irritation caused by frequent stooling. Maintaining the IV (Choice A) may be necessary but is not directly related to managing perianal skin integrity. Taking daily weights (Choice B) is important for monitoring fluid status but not the priority when addressing perianal skin integrity. While replacing lost calories (Choice C) is essential, promoting perianal skin integrity takes precedence in preventing complications associated with skin breakdown.

5. When teaching a class about trisomy 21, the instructor would identify the cause of this disorder as:

• A. nondisjunction.
• B. X-linked recessive inheritance.
• C. genomic imprinting.
• D. autosomal dominant inheritance.

Correct answer: A

Rationale: Trisomy 21, also known as Down syndrome, is caused by nondisjunction, which is an error in cell division that leads to the presence of an extra chromosome 21. This additional chromosome alters the normal genetic makeup, resulting in the characteristics associated with Down syndrome. Therefore, the correct answer is nondisjunction (Choice A). Choices B, C, and D are incorrect because Trisomy 21 is not caused by X-linked recessive inheritance, genomic imprinting, or autosomal dominant inheritance. Understanding the specific genetic mechanism involved in Trisomy 21 is crucial for grasping the basis of this chromosomal disorder.

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