Nursing Elites

1. In a well-child clinic, the nurse examines many children daily. Which of the following toddlers requires further follow-up?

• A. A 13-month-old who is unable to walk
• B. A 20-month-old who is only using 2 and 3 word sentences
• C. A 24-month-old who cries during examination
• D. A 30-month-old who is only drinking from a sip cup

Correct answer: D

Rationale: The correct answer is D because a 30-month-old should have developed the skill to drink from a regular cup by this age. Drinking from a sip cup at this stage may indicate a delay in development. Choices A, B, and C are not as concerning as they can be within the range of normal development. A 13-month-old not walking yet, a 20-month-old using 2 and 3 word sentences, and a 24-month-old crying during examination are all behaviors that can fall within the spectrum of typical development for their respective ages.

2. The nurse-manager is planning to transform safety ideas into prevention and protection strategies in the workplace. What committee should review and plan policies and education about safety in the workplace?

• A. policy and procedures committee
• B. quality assurance committee
• C. education committee
• D. ethics committee

Correct answer: B

Rationale: The quality assurance committee is responsible for reviewing and planning policies and education related to workplace safety. This committee focuses on ensuring the quality of care and services provided, which includes implementing safety measures. The policy and procedures committee primarily deals with developing and maintaining organizational policies and procedures. The education committee focuses on educational programs and initiatives, not specifically on safety policies. The ethics committee is concerned with ethical issues and dilemmas, not safety policies and education.

3. The nurse is caring for a 75-year-old client in congestive heart failure. Which finding suggests that digitalis levels should be reviewed?

• A. Extreme fatigue
• B. Increased appetite
• C. Intense itching
• D. Constipation

Correct answer: A

Rationale: Extreme fatigue can be a sign of digitalis toxicity, especially in older adults, and warrants a review of the client's medication levels and potential adjustment. Increased appetite, intense itching, and constipation are not typically associated with digitalis toxicity and do not directly indicate a need for a review of digitalis levels.

4. The increasing number of people who must learn to live with chronic illness in the community implies the need for the PHN to plan and implement a program on:

• A. communicable disease control
• B. health education
• C. child survival
• D. environmental education

Correct answer: B

Rationale: The correct answer is B: health education. Health education is crucial for individuals dealing with chronic illnesses as it helps them learn how to manage their conditions effectively. Communicable disease control (choice A) focuses on preventing the spread of infectious diseases, which is not directly related to managing chronic conditions. Child survival (choice C) pertains to initiatives aimed at reducing child mortality rates, which is not directly related to addressing chronic illnesses. Environmental education (choice D) involves raising awareness about environmental issues, which is also not directly related to helping individuals live with chronic illnesses.

5. An infant has just returned from surgery for placement of a gastrostomy tube as an initial treatment for tracheoesophageal fistula. The mother asks, 'When can the tube be used for feeding?' The nurse's best response would be which of these comments?

• A. "Feedings can begin in 5 to 7 days."
• B. "The use of the feeding tube can begin immediately."
• C. "The stomach contents and air must be drained first."
• D. "The incision healing must be complete before feeding."

Correct answer: C

Rationale: The correct answer is C: 'The stomach contents and air must be drained first.' Before starting feedings through a gastrostomy tube, it is essential to drain the stomach contents and air. This process helps prevent complications and ensures the proper functioning of the tube after placement. Choice A is incorrect because initiating feedings within 5 to 7 days may lead to complications if the stomach is not adequately prepared. Choice B is incorrect as feeding should not begin immediately to allow for proper preparation of the tube and the stomach. Choice D is incorrect because although incision healing is important, draining the stomach contents and air is a more immediate concern to prevent complications.

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