Nursing Elites

1. At an 8-month-old well-baby visit, the parent tells the nurse that her infant falls asleep at night during the last bottle feeding but wakes up when moved to the infant’s crib. What is the most appropriate response for the nurse to make?

• A. You should put your baby to sleep 1 hour earlier without the nighttime feeding but with a pacifier for soothing.
• B. You could place rice cereal in the last bottle feeding of the day to ensure a longer sleep pattern.
• C. You should have your partner give the last bottle of the day and observe whether your infant stays awake for your partner.
• D. You could increase daytime feeding intervals to every 4 hours and put your baby in the crib while the baby is still awake.

Correct answer: D

Rationale: Encouraging the baby to fall asleep in the crib while still awake can help establish healthy sleep habits and reduce night waking.

2. The nurse is teaching the family of a child with a long-term central venous access device about signs and symptoms of bacteremia. What finding indicates the presence of bacteremia?

• A. Hypertension
• B. Pain at the entry site
• C. Fever and general malaise
• D. Redness and swelling at the entry site

Correct answer: C

Rationale: Fever and general malaise are systemic signs of bacteremia, indicating that the infection may have spread beyond the local entry site. Localized pain, redness, and swelling are signs of a localized infection but do not necessarily indicate bacteremia.

3. In children with Type 1 diabetes, what is a common early sign of hypoglycemia?

• A. Irritability
• B. Rapid heartbeat
• C. Confusion
• D. Sweating

Correct answer: D

Rationale: Sweating is indeed one of the earliest signs of hypoglycemia in children with Type 1 diabetes. When blood sugar levels drop too low, the body releases stress hormones like adrenaline, which can lead to sweating. While irritability, rapid heartbeat, and confusion can also be seen in hypoglycemia, sweating is particularly common as a quick indicator of low blood sugar levels in children with Type 1 diabetes.

4. An eleven-year-old boy is admitted with a history of type 1 diabetes. What information about school age should the nurse use to formulate the teaching plan for daily injections?

• A. The parents do not need to learn the procedure.
• B. The child is old enough to give most of his injections.
• C. Self-injections will be possible when he is closer to adolescence.
• D. The child can learn about self-injections when he is able to reach all injection sites.

Correct answer: B

Rationale: By the age of eleven, many children are capable of administering their own insulin injections with supervision, fostering independence and better management of their diabetes. This age is appropriate for the child to take on more responsibility for their care. While parental involvement is still crucial for supervision and guidance, the child can start to learn and perform the injections themselves. Choice A is incorrect because parental involvement is important for safety and proper technique. Choice C is incorrect as waiting until closer to adolescence may delay the child's ability to manage their diabetes effectively. Choice D is incorrect as reaching injection sites is not the sole criteria; proper technique and supervision are essential.

5. Ongoing fluid losses can overwhelm the child’s ability to compensate, resulting in shock. What early clinical sign precedes shock?

• A. Tachycardia
• B. Slow respirations
• C. Warm, flushed skin
• D. Decreased blood pressure

Correct answer: A

Rationale: Tachycardia is an early sign of shock as the body tries to maintain cardiac output in the face of declining circulatory volume. Blood pressure often remains normal until late in the progression, at which point decompensated shock is occurring.

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