Nursing Elites

1. After surgery to correct hypertrophic pyloric stenosis (HPS) in a 3-week-old infant who had been formula-fed, which postoperative feeding order is appropriate?

• A. Thickened formula 24 hours after surgery
• B. Withholding feedings for the first 24 hours
• C. Regular formula feeding within 24 hours after surgery
• D. Additional glucose feedings as desired after the first 24 hours

Correct answer: C

Rationale: After surgery for hypertrophic pyloric stenosis (HPS), it is appropriate to resume regular formula feeding within 24 hours postoperatively to promote recovery. Choice A, thickened formula after surgery, may be too heavy for the infant's digestive system at this early stage. Withholding feedings for the first 24 hours (Choice B) is not recommended as early feeding helps with recovery. Additional glucose feedings (Choice D) are not necessary and may not provide the balanced nutrition required after surgery.

2. A healthcare provider is assessing a child with suspected rheumatic fever. What clinical manifestation is the provider likely to observe?

• A. Jaundice
• B. Peeling skin on the hands and feet
• C. High fever
• D. Severe joint pain

Correct answer: D

Rationale: Severe joint pain is a classic symptom of rheumatic fever, resulting from inflammation of the joints. Rheumatic fever primarily affects the joints, heart, skin, and the central nervous system. Jaundice (Choice A) is not typically associated with rheumatic fever. Peeling skin on the hands and feet (Choice B) is more characteristic of conditions like Kawasaki disease. While high fever (Choice C) can be present in rheumatic fever, it is not as specific or characteristic as severe joint pain.

3. A healthcare professional is reviewing the clinical records of infants and children with cardiac disorders who developed heart failure. What did the healthcare professional determine is the last sign of heart failure?

• A. Tachypnea
• B. Tachycardia
• C. Peripheral edema
• D. Periorbital edema

Correct answer: C

Rationale: Peripheral edema is often the last sign of heart failure in infants and children as it indicates significant fluid retention and circulatory compromise. Tachypnea (Choice A) and tachycardia (Choice B) are early signs of heart failure due to the body's compensatory mechanisms. Periorbital edema (Choice D) can occur in heart failure but is not typically the last sign; it is more commonly associated with renal or hepatic dysfunction.

4. Which of the following techniques represents the most appropriate method of opening the airway of an infant with no suspected neck injury?

• A. lift up the chin and hyperextend the neck
• B. tilt the head back without hyperextending the neck
• C. gently lift the chin while maintaining slight flexion of the neck
• D. perform the technique as you would for an older child or adult

Correct answer: B

Rationale: The correct technique for opening the airway of an infant with no suspected neck injury is to tilt the head back without hyperextending the neck. This method helps to keep the airway open without risking injury to the infant's delicate neck structures. Choice A, lifting up the chin and hyperextending the neck, can potentially harm the infant's neck. Choice C, gently lifting the chin while maintaining slight flexion of the neck, is not as effective as tilting the head back. Choice D is incorrect as infants require a different approach compared to older children or adults due to their anatomical differences.

5. A 3-year-old child is admitted to the hospital with a diagnosis of Kawasaki disease. What is the priority nursing intervention?

• A. Administering IV immunoglobulin
• B. Monitoring for coronary artery aneurysms
• C. Encouraging fluid intake
• D. Providing nutritional support

Correct answer: B

Rationale: The priority nursing intervention for a 3-year-old child with Kawasaki disease is monitoring for coronary artery aneurysms. Kawasaki disease can lead to coronary artery complications, making early detection crucial in preventing serious outcomes. Administering IV immunoglobulin is a standard treatment for Kawasaki disease but does not take precedence over monitoring for potential complications. Encouraging fluid intake and providing nutritional support are important aspects of care but are not the priority when compared to monitoring for coronary artery aneurysms to prevent long-term cardiac issues.

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