Nursing Elites

1. During a routine health assessment, the nurse notes that an 8-month-old infant has a significant head lag. Which is the most appropriate action?

• A. Recheck head control at the next visit
• B. Teach the parents appropriate exercises
• C. Schedule the child for further evaluation
• D. Refer the child for further evaluation if the anterior fontanel is still open

Correct answer: C

Rationale: Significant head lag at 8 months is concerning and warrants further evaluation, as it may indicate developmental delays or neurological issues.

2. A mother delivers an infant at 30 weeks gestation. The mother asks the nurse for information on nutrition and if formula would be better since the baby is premature. What is the foundation for the response to the mother by the nurse?

• A. Human milk is preferred over other types of nutrition.
• B. Human milk lacks essential nutrients when the infant is preterm.
• C. Commercial infant formulas are preferred over other types of nutrition.
• D. Commercial infant formulas have not been designed to meet the nutritional needs of preterm infants.

Correct answer: A

Rationale: The correct answer is A. Human milk is the preferred food for infants, including preterm infants. It contains essential ingredients necessary for the infant's growth and development. The mother should pump her breasts to provide milk for the infant if the child is receiving enteral feedings. Once the infant can coordinate breathing, sucking, and swallowing, breastfeeding directly is encouraged. Studies have shown that preterm infants fed fortified human milk have better outcomes compared to those fed commercial infant formulas. Commercial infant formulas may not fully meet the unique nutritional needs of preterm infants, leading to potential longer hospital stays. Therefore, human milk is the best choice for feeding premature infants.

3. During the 2-month well-child checkup, the nurse expects the infant to respond to sound in which manner?

• A. Respond to name
• B. React to loud noise with Moro reflex
• C. Turn his or her head to side when sound is at ear level
• D. Locate sound by turning his or her head in a curving arc

Correct answer: B

Rationale: At 2 months, infants typically react to loud noises with the Moro reflex, a startle response that is normal at this stage of development.

4. The nurse is caring for a child with the following order: Methylprednisolone (Solu-Medrol) 20 mg IV, every 6 hours. The nurse has Methylprednisolone 100 mg in 2 mL available. How many mL should the nurse administer with each dose?

• A. 0.4 mL
• B. 0.2 mL
• C. 0.5 mL
• D. 0.6 mL

Correct answer: A

Rationale: The correct dosage to administer 20 mg is 0.4 mL, calculated by dividing the dose (20 mg) by the concentration (100 mg in 2 mL). This calculation ensures the accurate administration of the prescribed medication. Choices B, C, and D are incorrect as they do not reflect the correct calculation based on the provided concentration of the medication.

5. What is the most common piece of medical equipment that can transmit harmful microorganisms among patients?

• A. Thermometer
• B. Stethoscope
• C. Injection needle
• D. Disposable gloves

Correct answer: B

Rationale: The correct answer is B: Stethoscope. A stethoscope is commonly used between patients, and if not correctly disinfected, it can be a dangerous source of spreading microorganisms. Thermometers typically have barriers to prevent this type of transmission. Injection needles are discarded immediately after use and not reused, making them an unlikely source of transmission. Similarly, disposable gloves are not reused, so they are also not a common source of harmful microorganism transmission.

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