Nursing Elites

1. An infant is diagnosed with Hirschsprung disease. What nursing intervention is essential before surgery?

• A. Administering antibiotics
• B. Ensuring bowel rest
• C. Performing regular enemas
• D. Maintaining NPO status

Correct answer: D

Rationale: Maintaining NPO (nothing by mouth) status is essential before surgery for a patient with Hirschsprung disease to prevent aspiration. Administering antibiotics, ensuring bowel rest, and performing regular enemas are not the priority interventions before surgery for this condition. Administering antibiotics may be necessary in the postoperative period to prevent infection, ensuring bowel rest can be beneficial but is not the priority, and performing regular enemas is not typically recommended before surgery for Hirschsprung disease.

2. Which of the following parameters would be LEAST reliable when assessing the perfusion status of a 2-year-old child with possible shock?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: Systolic blood pressure is the least reliable parameter when assessing the perfusion status of a 2-year-old child with possible shock. In pediatric patients, especially young children, blood pressure may not decrease until significant shock has already occurred, making it a late indicator of inadequate perfusion. Depending solely on systolic blood pressure to evaluate perfusion status in this age group can lead to a delay in appropriate interventions. Distal capillary refill time, skin color, and temperature changes, and the presence of peripheral pulses are more sensitive and early indicators of perfusion status in pediatric patients. Monitoring distal capillary refill provides information on peripheral perfusion, while changes in skin color and temperature can signal circulatory compromise. Evaluating the presence or absence of peripheral pulses offers insights into vascular perfusion. These parameters offer more reliable and prompt feedback on a child's perfusion status compared to systolic blood pressure.

3. A child with a diagnosis of celiac disease is admitted to the hospital. What dietary restriction should the nurse teach the parents?

• A. Avoid dairy products
• B. Avoid gluten
• C. Avoid high-fat foods
• D. Avoid foods high in sugar

Correct answer: B

Rationale: The correct answer is B: 'Avoid gluten.' Children with celiac disease must follow a gluten-free diet to prevent symptoms and intestinal damage. Gluten is a protein found in wheat, barley, and rye, which triggers an immune response in individuals with celiac disease. Choices A, C, and D are incorrect because while some individuals with celiac disease may also have lactose intolerance or may need to manage fat or sugar intake for overall health, the primary dietary restriction for celiac disease is avoiding gluten to maintain gastrointestinal health.

4. While teaching a parent how to prevent accidents while caring for a 6-month-old infant, what motor development ability should be emphasized?

• A. Sits up
• B. Rolls over
• C. Crawls short distances
• D. Stands while holding on to furniture

Correct answer: B

Rationale: The correct answer is B: Rolls over. At 6 months, most infants can roll over, increasing the risk of falls. It is important to emphasize to the parent the need for careful supervision to prevent accidents. While choices A, C, and D are also milestones in infant motor development, rolling over at this age poses a higher risk of accidents due to the increased mobility and potential for falls.

5. A child with a fever is prescribed acetaminophen. What should the caregiver teach the parents about administering this medication?

• A. Administer the medication with food
• B. Measure the dose with a household spoon
• C. Measure the dose with a proper measuring device
• D. Administer the medication only when the child has a high fever

Correct answer: C

Rationale: The correct answer is to measure the dose with a proper measuring device. Using a household spoon can lead to inaccurate dosing, which can be dangerous. Administering the medication with food or only when the child has a high fever are not the essential instructions related to the safe and effective administration of acetaminophen.

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