Nursing Elites

1. An infant who had cardiac surgery for a congenital defect is to be discharged. What should the nurse emphasize to the parents regarding administering the prescribed antibiotic?

• A. Give the antibiotic between feedings.
• B. Ensure that the antibiotic is administered as prescribed.
• C. Shake the bottle thoroughly before administering the antibiotic.
• D. Keep the antibiotic in the refrigerator after opening the bottle.

Correct answer: B

Rationale: The correct answer is B: 'Ensure that the antibiotic is administered as prescribed.' It's crucial to stress the importance of following the prescribed antibiotic regimen to prevent infections and promote proper healing after cardiac surgery. Choice A is incorrect because it does not address the fundamental aspect of adherence to the prescription. Choice C is incorrect as shaking the bottle may not be necessary for all antibiotics and is not a critical instruction in this context. Choice D is incorrect as storage instructions are not directly related to the administration of the antibiotic as prescribed, which is the primary concern in this scenario.

2. A parent arrives in the emergency clinic with a 3-month-old baby who has difficulty breathing and prolonged periods of apnea. Which assessment data should alert the nurse to suspect shaken baby syndrome (SBS)?

• A. Birth occurred before 32 weeks’ gestation
• B. Lack of stridor and adventitious breath sounds
• C. Previous episodes of apnea lasting 10 to 15 seconds
• D. Retractions and use of accessory respiratory muscles

Correct answer: D

Rationale: Retractions and the use of accessory respiratory muscles are signs of respiratory distress in infants. These clinical manifestations can be associated with trauma, such as shaken baby syndrome (SBS), which can lead to severe head injuries and respiratory compromise. Birth before 32 weeks’ gestation (Choice A) is more related to prematurity complications rather than SBS. The absence of stridor and adventitious breath sounds (Choice B) may not be specific indicators of SBS. Previous episodes of apnea lasting 10 to 15 seconds (Choice C) alone may not be as concerning as the presence of retractions and use of accessory muscles in the context of a distressed infant.

3. A child is being assessed by a nurse for suspected nephrotic syndrome. What clinical manifestation is the nurse likely to observe?

• A. Jaundice
• B. Edema
• C. Hypertension
• D. Polyuria

Correct answer: B

Rationale: Edema is a hallmark clinical manifestation of nephrotic syndrome. In nephrotic syndrome, there is increased permeability of the glomerular filtration barrier, leading to protein loss in the urine (proteinuria). The decrease in serum protein levels results in a reduced oncotic pressure, leading to fluid shifting from the intravascular space into the interstitial spaces, causing edema. Jaundice (choice A) is not typically associated with nephrotic syndrome. Hypertension (choice C) is more commonly seen in conditions like nephritic syndrome. Polyuria (choice D) is excessive urination and is not a prominent feature of nephrotic syndrome.

4. A nurse on the pediatric unit is observing the developmental skills of several 2-year-old children in the playroom. Which child should the nurse continue to evaluate?

• A. Cannot stand on one foot
• B. Builds a tower of 7 blocks
• C. Uses echolalia when speaking
• D. Colors outside the lines of a picture

Correct answer: C

Rationale: The correct answer is C. Using echolalia, which is the repetition of words or phrases, is not typical for a 2-year-old child and may indicate the need for further evaluation. Choices A, B, and D are all within the expected developmental skills for a 2-year-old. While most 2-year-olds may not be able to stand on one foot, it is not a cause for concern at this age. Building a tower of 7 blocks and coloring outside the lines of a picture are both appropriate for a 2-year-old's developmental skills.

5. A newborn with an anorectal anomaly had an anoplasty performed. At the 2-week follow-up visit, a series of anal dilations are begun. What should the nurse recommend to the parents to help prevent the infant from becoming constipated?

• A. Use a soy formula.
• B. Breastfeed if possible.
• C. Administer a suppository nightly.
• D. Offer glucose water between feedings.

Correct answer: B

Rationale: Breastfeeding is the best recommendation to help prevent constipation in infants. Breast milk is easily digestible and contains the right balance of nutrients, which can lead to softer stools, thus reducing the likelihood of constipation. Offering a soy formula (Choice A) may not necessarily prevent constipation as effectively as breast milk due to differences in nutrient composition. Administering a suppository nightly (Choice C) is not a routine measure for preventing constipation in infants and may not be suitable for regular use in this scenario. Offering glucose water (Choice D) between feedings is not recommended as it does not provide the necessary nutrients found in breast milk, which are essential for preventing constipation and promoting overall health in newborns.

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