Nursing Elites

1. The nurse is caring for an infant who was born 24 hr ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include hyperactive reflexes, tremors, sneezing, and a high-pitched shrill cry. What does the nurse consider as a possible diagnosis for this infant?

• A. Seizure disorder
• B. Narcotic withdrawal
• C. Placental insufficiency
• D. Meconium aspiration syndrome

Correct answer: B

Rationale: In this case, the infant's symptoms are consistent with narcotic withdrawal. Infants exposed to drugs in utero may display withdrawal symptoms starting around 12 to 24 hours post-birth. The presentation often includes hyperactive reflexes, tremors, sneezing, high-pitched shrill cry, poor feeding, and sucking avidly on hands. Signs such as loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating are common. These symptoms are not indicative of a seizure disorder. Placental insufficiency typically leads to a small-for-gestational-age child, which is not mentioned in the scenario. Meconium aspiration syndrome primarily presents with respiratory distress, not the symptoms described in this case.

2. At what age is the first dose of the hepatitis A vaccine recommended to be started?

• A. 1 year
• B. 1 month
• C. 12 years
• D. It is not recommended at any age

Correct answer: A

Rationale: The correct answer is A: 1 year. The hepatitis A vaccine is now recommended for all children starting at age 1 year (i.e., 12 to 23 months). This is due to the recognition of hepatitis A as a significant child health problem, especially in areas with high infection rates. The virus is primarily spread through fecal-oral transmission, person-to-person contact, ingestion of contaminated food or water, and rarely through blood transfusion. Administering the first dose at 1 year helps protect children from this infection. Choices B and C are incorrect as the vaccine is not recommended at 1 month or 12 years. Choice D is also incorrect as the hepatitis A vaccine is recommended at a specific age to prevent the infection.

3. The parents of a young child ask the nurse for suggestions about discipline. When discussing the use of time-outs, which should the nurse include?

• A. Send the child to his or her room if the child has one.
• B. A general rule for length of time is 1 hour per year of age.
• C. Select an area that is safe and nonstimulating, such as a hallway.
• D. If the child cries, refuses, or is more disruptive, try another approach.

Correct answer: C

Rationale: Time-outs should be in a safe, nonstimulating area, with the length typically being 1 minute per year of the child's age, not 1 hour.

4. A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care?

• A. Use an 18-gauge needle if possible.
• B. Show the child the equipment to be used before the procedure.
• C. If not successful after four attempts, have another nurse try.
• D. Restrain the child completely.

Correct answer: B

Rationale: Showing the child the equipment before the procedure helps build trust and reduces fear. Using an 18-gauge needle is too large for a child, and multiple attempts can increase trauma. Restraining completely can increase fear and anxiety.

5. The nurse has just started assessing a young child who is febrile and appears ill. There is hyperextension of the child's head (opisthotonos) with pain on flexion. Which is the most appropriate action?

• A. Ask the parent when the neck was injured
• B. Refer for immediate medical evaluation
• C. Continue assessment to determine the cause of the neck pain
• D. Record head lag on the assessment record and continue the assessment of the child

Correct answer: B

Rationale: Opisthotonos with pain on flexion is a sign of possible meningitis or other serious neurological conditions, requiring immediate medical evaluation.

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