Nursing Elites

1. The mother of a one-month-old calls the clinic to report that the back of her infant's head is flat. How should the nurse respond?

• A. Turn the infant on the left side braced against the crib when sleeping.
• B. Prop the infant in a sitting position with a cushion when not sleeping.
• C. Place a small pillow under the infant's head while lying on the back.
• D. Position the infant on the stomach occasionally when awake and active.

Correct answer: D

Rationale: Positioning the infant on the stomach occasionally when awake and active can help prevent flat spots on the head. This position allows for more natural movement and prevents prolonged pressure on one area of the head, reducing the risk of developing a flat spot. Turning the infant on the left side braced against the crib when sleeping (choice A) is not recommended as it does not address the issue of flat spots. Propping the infant in a sitting position with a cushion when not sleeping (choice B) may increase the risk of falls and is not suitable for a one-month-old. Placing a small pillow under the infant's head while lying on the back (choice C) should be avoided due to the risk of suffocation and sudden infant death syndrome (SIDS).

2. A child is recovering from an appendectomy. The parent asks when the child can resume normal activities. What is the best response by the nurse?

• A. The child can resume normal activities as soon as they feel up to it
• B. The child should avoid strenuous activities for at least 2 weeks
• C. The child can resume normal activities after the stitches are removed
• D. The child should avoid all physical activities for the next month

Correct answer: B

Rationale: After an appendectomy, it is important for the child to avoid strenuous activities for at least 2 weeks to allow for proper healing. Resuming normal activities too soon can put unnecessary strain on the healing process and increase the risk of complications.

3. The nurse is caring for a 15-year-old adolescent who is admitted with a diagnosis of bulimia nervosa. The adolescent’s vital signs are stable, but the nurse notes that the client has dry skin and appears thin. What is the nurse’s priority action?

• A. Initiate a structured eating plan for the client
• B. Establish a therapeutic relationship with the client
• C. Monitor the client’s electrolyte levels
• D. Provide education on healthy eating habits

Correct answer: C

Rationale: In clients with bulimia nervosa, electrolyte imbalances are common due to purging behaviors and can lead to severe complications. Monitoring electrolyte levels is essential to detect and manage any imbalances promptly, as they can be life-threatening.

4. A 9-week-old infant is scheduled for cleft lip repair. Which information is most important for the nurse to convey to the surgeon before transporting the infant to the surgical suite?

• A. Red blood cell count of 2.3 million/mm³
• B. White blood cell count of 10,000/mm³
• C. Weight gain of 2 pounds since birth
• D. Urine specific gravity is 1.011

Correct answer: A

Rationale: The correct answer is A because a low red blood cell count may indicate anemia, which could pose risks during surgery. Anemia can affect oxygen delivery to tissues, impacting wound healing and overall surgical outcomes. The other options, such as white blood cell count, weight gain, and urine specific gravity, are less critical for immediate surgical considerations. White blood cell count is more related to infection risk postoperatively rather than immediate surgical risk. Weight gain reflects good overall growth but does not impact the immediate surgical situation. Urine specific gravity is more indicative of hydration status rather than immediate surgical risk.

5. What advice should be provided by the practical nurse to the mother of a school-age child with acute diarrhea and mild dehydration who is occasionally vomiting despite being given an oral rehydration solution (ORS)?

• A. Continue to give ORS frequently in small amounts.
• B. Alternate between ORS and carbonated beverages.
• C. Take the child to the hospital for intravenous fluids.
• D. Place the child NPO for the next eight to nine hours.

Correct answer: A

Rationale: The practical nurse should advise the mother to continue providing the oral rehydration solution (ORS) frequently in small amounts. It is essential to continue ORS administration to prevent dehydration, even if the child is occasionally vomiting. Small, frequent amounts of ORS help maintain hydration levels in children with acute diarrhea and mild dehydration.

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