Nursing Elites

1. What is an essential nursing care intervention for a neonate with a suspected tracheoesophageal fistula?

• A. Feed glucose water only.
• B. Elevate the patient's head for feedings.
• C. Raise the patient's head and give nothing by mouth.
• D. Avoid suctioning unless the infant is cyanotic.

Correct answer: C

Rationale: Raising the patient’s head and giving nothing by mouth is crucial in managing tracheoesophageal fistula. This intervention helps prevent aspiration and further complications until surgical correction can be performed. Feeding the neonate or suctioning could exacerbate the condition by risking aspiration. Elevating the head for feedings does not address the primary concern of preventing oral intake, making it less appropriate than the correct answer.

2. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?

• A. Surgical therapy is indicated.
• B. Place the infant in a prone position for sleep after feeding.
• C. Thicken feedings and enlarge the nipple hole.
• D. Reduce the frequency of feeding by encouraging larger volumes of formula.

Correct answer: C

Rationale: The correct recommendation for decreasing the number and total volume of emesis in an infant with gastroesophageal reflux is to thicken feedings and enlarge the nipple hole. Thicker feedings can reduce the frequency and volume of emesis by making the food less likely to be regurgitated. Enlarging the nipple hole helps ensure the thickened feedings can pass through. Surgical therapy (Choice A) is not the initial recommendation for managing gastroesophageal reflux in infants. Placing the infant in a prone position for sleep after feeding (Choice B) is not recommended due to the increased risk of sudden infant death syndrome (SIDS). Reducing the frequency of feeding by encouraging larger volumes of formula (Choice D) can exacerbate the reflux symptoms.

3. What interventions would the nurse implement to maintain the skin integrity of a preterm infant born at 30 weeks?

• A. Avoid using alkaline-based soap.
• B. Bathe the infant with sterile water.
• C. Cleanse skin with a gentle alkaline-based soap and water.
• D. Thoroughly rinse skin with plain water after bathing in a mild hexachlorophene solution.

Correct answer: B

Rationale: To maintain the skin integrity of a preterm infant born at 30 weeks, the nurse should bathe the infant with sterile water no more than two or three times per week. The eyes, oral and diaper areas, and pressure points should be cleansed daily. It is essential to avoid using alkaline-based soaps as they might destroy the 'acid mantle' of the skin. Additionally, cleansing with mild solutions and rinsing thoroughly with plain water is recommended to prevent skin irritation and maintain skin integrity. Therefore, options A, C, and D are incorrect as they do not align with the best practices for preterm infant skin care.

4. When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?

• A. 2 months of age, before hospital discharge.
• B. Birth before discharge from the hospital.
• C. 6 months of age, at the third well-child visit.
• D. No time (this vaccine is not currently recommended).

Correct answer: B

Rationale: If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.

5. The nurse is reviewing the importance of role learning for children. The nurse understands that children's roles are primarily shaped by which members?

• A. Peers
• B. Parents
• C. Siblings
• D. Grandparents

Correct answer: B

Rationale: Parents play the primary role in shaping their children's roles and behaviors, especially in early childhood, through modeling, guidance, and expectations.

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