Nursing Elites

1. Why should a nurse plan an evening snack for a child receiving Novolin N insulin?

• A. To encourage the child to adhere to the diet.
• B. To provide energy for immediate use.
• C. To help the child gain weight with extra calories.
• D. To counteract late insulin activity with nourishment.

Correct answer: D

Rationale: The correct answer is D. Novolin N insulin peaks in the evening, which can lead to hypoglycemia during the night. Providing an evening snack helps to counteract the late insulin activity and prevent hypoglycemia. Choice A is incorrect because the primary reason for the evening snack is not to encourage adherence to the diet. Choice B is incorrect as the snack is not primarily for immediate energy use. Choice C is incorrect as the goal of the snack is not to help the child gain weight but to manage blood sugar levels.

2. While performing a visual inspection of a 30-year-old woman in active labor, you can see the umbilical cord at the vaginal opening. After providing high concentration oxygen, you should next

• A. massage the uterus to facilitate delivery of the fetus
• B. relieve pressure from the cord with your gloved fingers
• C. place the mother on her left side and provide rapid transport
• D. elevate the mother's lower extremities and provide immediate transport

Correct answer: B

Rationale: In the scenario described, when the umbilical cord is visible at the vaginal opening, the priority is to relieve pressure from the cord with gloved fingers. This action helps prevent cord compression and ensures continued oxygenation to the fetus, which is crucial for the baby's well-being. Massaging the uterus or elevating the mother's lower extremities is not the correct course of action in this situation and may potentially worsen the condition. Placing the mother on her left side and providing rapid transport is not the immediate step needed to address the visible umbilical cord; relieving pressure from the cord takes precedence to maintain fetal oxygen supply.

3. A nurse is reviewing the laboratory report of a child with tetralogy of Fallot that indicates an elevated RBC count. What does the nurse identify as the cause of the polycythemia?

• A. Low tissue oxygen needs
• B. Tissue oxygen needs
• C. Diminished iron levels
• D. Hypertrophic cardiac muscle

Correct answer: B

Rationale: The correct answer is B: Tissue oxygen needs. Polycythemia occurs in response to chronic hypoxia, leading the body to increase red blood cell production to enhance oxygen delivery. In tetralogy of Fallot, a congenital heart defect that results in reduced oxygen levels in the blood, the body compensates by producing more red blood cells. Choice A is incorrect as low tissue oxygen needs would not trigger polycythemia. Choice C, diminished iron levels, is not the cause of polycythemia in this case. Choice D, hypertrophic cardiac muscle, is unrelated to the pathophysiology of polycythemia in tetralogy of Fallot.

4. The nurse is planning a discussion group for parents with children who have cancer. How would the nurse describe a difference between cancer in children and adults?

• A. Most childhood cancers affect tissues rather than organs.
• B. Childhood cancers are usually localized when found.
• C. Unlike adult cancers, childhood cancers are less responsive to treatment.
• D. The majority of childhood cancers can be prevented.

Correct answer: A

Rationale: The correct answer is A. Most childhood cancers, such as leukemias and sarcomas, affect tissues rather than specific organs, unlike many adult cancers. Choice B is incorrect because childhood cancers can be localized or spread, similar to adult cancers. Choice C is incorrect because childhood cancers can be highly responsive to treatment, especially when diagnosed early. Choice D is incorrect because the majority of childhood cancers cannot be prevented as they are often due to genetic mutations or unknown causes.

5. One principle to be followed for children with type 1 diabetes is to provide for the variability of the child’s activity. What should the nurse teach the child about how to compensate for increased physical activity?

• A. Eat more food when planning to exercise more than usual.
• B. Take oral, not injectable insulin, on days of heavy exercise.
• C. Take insulin in the morning when extra exercise is anticipated.
• D. Eat foods that contain sugar to compensate for the extra exercise.

Correct answer: A

Rationale: The correct answer is to eat more food when planning to exercise more than usual. Increased physical activity requires more energy, so additional food intake is necessary to compensate for the increased energy expenditure. This helps maintain blood sugar levels within the target range. Choice B is incorrect because the mode of insulin administration does not change based on physical activity; the type and dose of insulin remain the same unless adjusted by a healthcare provider. Choice C is incorrect because insulin timing should not be adjusted solely based on anticipated exercise; consistent timing of insulin doses is crucial for stable blood sugar control. Choice D is incorrect because consuming foods with sugar may lead to unstable blood sugar levels and is not the recommended way to compensate for extra exercise, as it can result in sudden spikes and drops in blood glucose levels, affecting overall diabetes management.

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