Nursing Elites

1. 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.

2. What finding would the nurse expect to assess in a child with hypothyroidism?

• A. Nervousness
• B. Heat intolerance
• C. Smooth velvety skin
• D. Weight gain

Correct answer: D

Rationale: In a child with hypothyroidism, weight gain is a typical finding due to the slowed metabolism associated with the condition. This occurs because thyroid hormone levels are insufficient to regulate metabolism effectively. Choices A, B, and C are not typically associated with hypothyroidism. Nervousness is more commonly seen in conditions like hyperthyroidism, where there is an excess of thyroid hormones. Heat intolerance may be seen in hyperthyroidism as well, where the body's metabolism is increased. Smooth velvety skin is a characteristic finding in conditions like Cushing's syndrome, where there is excess cortisol production.

3. The nurse is teaching the parents of a 1-month-old girl with Down syndrome how to maintain good health for the child. Which instruction would the nurse be least likely to include?

• A. Getting cervical radiographs between 3 and 5 years of age
• B. Adhering to the special dietary needs of the child
• C. Getting an echocardiogram before 3 months of age
• D. Monitoring for symptoms of respiratory infection

Correct answer: B

Rationale: The correct answer is B. While special dietary needs may be important for a child with Down syndrome, they are typically not the primary concern for a 1-month-old. The nurse would be least likely to focus on this aspect as immediate issues such as monitoring for congenital heart defects (echocardiogram), cervical spine abnormalities (radiographs), and respiratory infections are more critical in the early months. Adhering to dietary needs is important, but it is usually addressed as the child grows older and is not the priority during the infant stage.

4. What explanation should the nurse give a parent about the purpose of a tetanus toxoid injection for their child?

• A. Passive immunity is conferred temporarily.
• B. Long-lasting active immunity is conferred.
• C. Lifelong active natural immunity is conferred.
• D. Passive natural immunity is conferred temporarily.

Correct answer: B

Rationale: The correct answer is B: Long-lasting active immunity is conferred. Tetanus toxoid injection works by stimulating the child's body to produce its antibodies, providing long-lasting active immunity. Choice A is incorrect because passive immunity is not conferred for life; it is temporary and involves receiving antibodies rather than producing them internally. Choice C is incorrect as the immunity conferred by the tetanus toxoid injection is not lifelong natural immunity but rather active immunity stimulated by the body's immune response. Choice D is also incorrect since passive natural immunity is not conferred by the tetanus toxoid injection, and it is not temporary.

5. A 13-year-old girl tells the nurse at the pediatric clinic that she took a pregnancy test and it was positive. She adds that her grandfather, with whom she, her younger sisters, and her mother live, has repeatedly molested her for the past 3 years. When the nurse asks the girl if she has told this to anyone, she replies, 'Yes, but my mother doesn’t believe me.' Legally, who should the nurse notify?

• A. Police regarding a potential sex crime
• B. Health care provider to confirm the pregnancy
• C. Child Protective Services for immediate intervention
• D. The girl’s mother about the positive pregnancy test result

Correct answer: C

Rationale: In cases of child abuse and ongoing molestation, as described in the scenario, the primary concern is the safety and well-being of the child. Child Protective Services should be notified immediately for intervention to protect the girl and other children in the household from further harm. The police may be involved later to investigate the criminal aspect of the abuse. Notifying the healthcare provider solely to confirm the pregnancy or informing the girl’s mother about the positive test result does not address the urgent need for intervention and protection from abuse. Child Protective Services are trained to handle such cases and provide the necessary support and protection for the child and other vulnerable individuals in the family. Immediate action is crucial to ensure the girl's safety and prevent further harm.

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