Nursing Elites

1. At what point in the hospitalization of the pediatric patient should discharge planning and teaching begin?

• A. Post-operatively
• B. Right when the patient is being discharged with the parents and support members present
• C. On the morning that the patient is scheduled to go home
• D. On admission

Correct answer: D

Rationale: Discharge planning should begin on admission to ensure that all necessary teaching and preparations are completed in a timely manner. Starting discharge planning early allows for a comprehensive assessment of the patient's needs, coordination with the healthcare team, and adequate time for patient and family education. Choice A, post-operatively, is too late in the process and may lead to rushed planning. Choice B, right at discharge, may not allow enough time for thorough preparation. Choice C, on the morning of discharge, also does not provide sufficient time for effective planning and education.

2. What is a priority intervention for an infant with a temporary colostomy for Hirschsprung disease?

• A. Teaching how to irrigate the colostomy
• B. Protecting the skin around the colostomy
• C. Discussing the implications of a colostomy during puberty
• D. Using simple, straightforward language to prepare the child

Correct answer: B

Rationale: Protecting the skin around the colostomy is crucial to prevent irritation and infection, which are common complications in infants with colostomies. Teaching and discussing long-term implications are important but secondary to immediate skin care needs.

3. After 8 weeks in the neonatal intensive care unit, Chris will soon be discharged. His parents seem apprehensive and worry that he may still be in danger. What is this considered by the nurse?

• A. A common parental reaction
• B. Suggestive of maladaptation
• C. A reason to postpone discharge
• D. Suggestive of inadequate bonding

Correct answer: A

Rationale: Parents become apprehensive and worried as the time for discharge approaches, which is a common parental reaction. They often have concerns and insecurities about caring for their infant. The worry about potential dangers is a normal adaptive response reflecting the parents' concern for their child's well-being. It is essential for healthcare providers to acknowledge these feelings and support parents in gaining confidence in caring for their infant. Choices B, C, and D are incorrect because the parents' apprehension in this context is a typical emotional response and not indicative of maladaptation, a reason to postpone discharge, or inadequate bonding.

4. An infant with short bowel syndrome will be on total parenteral nutrition (TPN) for an extended period of time. What should the nurse monitor the infant for?

• A. Central venous catheter infection, electrolyte losses, and hyperglycemia
• B. Hypoglycemia, catheter migration, and weight gain
• C. Venous thrombosis, hyperlipidemia, and constipation
• D. Catheter damage, red currant jelly stools, and hypoglycemia

Correct answer: A

Rationale: Infants with short bowel syndrome requiring prolonged total parenteral nutrition (TPN) are susceptible to central venous catheter infections, electrolyte losses, and hyperglycemia. Monitoring for these complications is crucial to prevent serious outcomes. Choices B, C, and D are incorrect because they do not reflect the common complications associated with prolonged TPN in infants.

5. What is the most critical physiologic change required of newborns at birth?

• A. Transition from fetal to neonatal breathing
• B. Body temperature maintenance
• C. Stabilization of fluid and electrolytes
• D. Closure of fetal shunts in the heart

Correct answer: A

Rationale: The correct answer is A: Transition from fetal to neonatal breathing. The onset of breathing is the most immediate and critical physiologic change required for the transition to extrauterine life. Factors that interfere with this normal transition increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis. While body temperature maintenance, stabilization of fluid and electrolytes, and closure of fetal shunts in the heart are crucial changes in the transition to extrauterine life, breathing and the exchange of oxygen for carbon dioxide must take precedence as they are essential for newborn survival.

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