Nursing Elites

1. When assessing a newborn infant with low set ears, short palpebral fissures, flat nasal bridge, and an indistinct philtrum, a priority maternal assessment by the nurse should be to ask about

• A. Alcohol use during pregnancy
• B. Usual nutritional intake
• C. Family genetic disorders
• D. Maternal and paternal ages

Correct answer: A

Rationale: The correct answer is A: Alcohol use during pregnancy. The physical features mentioned are indicative of fetal alcohol syndrome, a condition caused by maternal alcohol consumption during pregnancy. It is crucial for the nurse to inquire about alcohol use as it can help in diagnosing and managing the infant's condition. Choices B, C, and D are incorrect as they are not directly associated with the physical findings described in the newborn, which specifically point towards a potential history of alcohol exposure during pregnancy.

2. The appropriate order of steps in active management of the third stage of labor includes:

• A. Cord clamping and cutting, controlled cord traction, ergometrine administration, and inspection to ensure the placenta is intact.
• B. Intravenous oxytocin, cord clamping and cutting, and fundal massage.
• C. Intramuscular injection of oxytocin, controlled cord traction with counter traction to the uterus, and uterine massage.
• D. Controlled cord traction, fundal massage, and oxytocin.

Correct answer: C

Rationale: The correct sequence of steps in active management of the third stage of labor includes intramuscular injection of oxytocin to prevent postpartum hemorrhage, controlled cord traction with counter traction to the uterus to facilitate placental delivery, and uterine massage to aid in uterine contraction and prevent excessive bleeding. Choice A is incorrect because ergometrine administration is not routinely recommended in active management. Choice B is incorrect as intravenous oxytocin is not the preferred route of administration. Choice D is incorrect as the order of steps is not accurate.

3. As an important tool for planning a community health survey was conducted, the first tangible outcome of collaboration and teamwork with the Local Health Department and its Rural Health Units (RHUs) was seen. This later led to case-finding activities via collection and examination of stools from children for suspected parasitism. Which of the following community nursing diagnoses will guide the Parish Health Team for concrete action?

• A. Parasitism as a foreseeable crisis
• B. Malnutrition as a health deficit
• C. Parasitism as a health deficit
• D. Parasitism as a health threat

Correct answer: D

Rationale: The correct answer is 'Parasitism as a health threat.' This choice accurately describes the ongoing issue of parasitic infections in the community, highlighting the seriousness and urgency of the problem. Choice A ('Parasitism as a foreseeable crisis') is incorrect as it does not emphasize the immediate danger posed by parasitic infections. Choice B ('Malnutrition as a health deficit') is not the most relevant diagnosis considering the context provided. Choice C ('Parasitism as a health deficit') is also incorrect as it fails to capture the level of risk and urgency associated with parasitic infections in this scenario.

4. Which topic should be included in planning a secondary prevention project for the local retirement community?

• A. Safety measures in the home.
• B. Adult immunization program.
• C. Rehabilitation after surgery.
• D. Vision and hearing screening.

Correct answer: D

Rationale: In planning a secondary prevention project for the local retirement community, vision and hearing screening should be included. This is crucial as sensory impairments are common among older adults and early detection through screening can help in preventing further complications. Safety measures in the home, adult immunization programs, and rehabilitation after surgery are important but fall more under primary or tertiary prevention strategies rather than secondary prevention, which focuses on early detection and intervention to prevent the progression of health conditions.

5. A community hospital is an example of which level of health care?

• A. Secondary level health care
• B. Primary health care
• C. Tertiary level care
• D. Intermediate level care

Correct answer: A

Rationale: A community hospital is categorized under secondary level health care. Secondary level health care facilities, like community hospitals, provide specialized outpatient care, diagnostic services, and treatment that are more complex than what is offered in primary health care settings. Choice B, primary health care, refers to basic and routine health care services typically provided by family doctors or general practitioners, which is not the level of care provided by community hospitals. Tertiary level care (choice C) involves highly specialized and complex medical services such as neurosurgery or organ transplants, which are beyond the scope of services provided by community hospitals. Intermediate level care (choice D) is not a recognized category in the hierarchy of health care levels.

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