Nursing Elites

1. A thorough systemic physical assessment is necessary in the extremely low-birth-weight (ELBW) infant to detect what?

• A. Weight gain reflective of fluid retention
• B. Difficulties in maternal-child attachment
• C. Subtle changes that may be indicative of an underlying problem
• D. Changes in Apgar score over the first 24 hours of life

Correct answer: C

Rationale: In extremely low-birth-weight (ELBW) infants, a thorough systemic physical assessment is crucial to detect subtle changes that may indicate an underlying problem. These infants are highly vulnerable and may show signs of stress through changes in feeding behavior, activity, color, oxygen saturation, or vital signs. Monitoring weight in ELBW infants primarily reflects genitourinary function rather than fluid retention. Difficulties in maternal-child attachment are important but are usually assessed during parental visits and are not the primary focus of a systemic physical assessment. Changes in the Apgar score are used immediately after birth to assess the transition to extrauterine life and are not as relevant in the following 24 hours to detect ongoing subtle issues.

2. The LPN is assessing for fontanels on the head of a 6-month-old. Which fontanel is expected to still be present?

• A. Posterior
• B. Anterior
• C. Sphenoid
• D. Lambdoid

Correct answer: B

Rationale: The correct answer is B: Anterior. The anterior fontanel usually remains open until about 12-18 months of age, while the posterior fontanel closes by 2-3 months. Choices A, C, and D are incorrect as the posterior fontanel closes by 2-3 months of age, and the sphenoid and lambdoid fontanels are not typically assessed in routine infant head examinations.

3. A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?

• A. Give the child a computer-animated game that presents information on the management of chronic renal failure.
• B. Set up a meeting with some older teens who have chronic renal failure and have been managing their disease effectively.
• C. Arrange for a physician to sit down and talk to the child about the risks related to noncompliance with medications.
• D. Discuss with the child’s parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.

Correct answer: B

Rationale: Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.

4. Which is usually the only symptom of pediculosis capitis (head lice)?

• A. Itching
• B. Vesicles
• C. Scalp rash
• D. Localized inflammatory response

Correct answer: A

Rationale: Itching is typically the primary and most common symptom of pediculosis capitis due to the lice bites on the scalp.

5. The nurse is preparing to administer a prescribed, as-needed antiemetic drug for a child diagnosed with cancer. Which action by the nurse is most appropriate?

• A. Administering the drug only if the child is nauseated.
• B. Administering the drug prophylactically before the next dose of chemotherapy.
• C. Administering the drug after the next dose of chemotherapy.
• D. Administering the drug only if the child is experiencing diarrhea.

Correct answer: B

Rationale: Administering the antiemetic prophylactically before the next dose of chemotherapy is the most appropriate action. This approach helps prevent nausea and vomiting associated with chemotherapy. Waiting until the child is already nauseated, as stated in option A, is less effective as it is reactive rather than proactive. Administering the drug after chemotherapy, as in option C, may not be as beneficial in preventing chemotherapy-induced nausea and vomiting. Option D, administering the drug only if the child is experiencing diarrhea, is not relevant to the prevention of chemotherapy-induced nausea.

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