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. The nurse is teaching a client to prevent future urinary tract infections (UTIs). What factor is most important to emphasize as the potential cause?

• A. Poor hygiene
• B. Constipation
• C. Urinary stasis
• D. Congenital anomalies

Correct answer: C

Rationale: Urinary stasis is the most important factor in the development of UTIs because it provides an environment for bacterial growth. While poor hygiene and congenital anomalies are contributing factors, preventing urinary stasis is key in UTI prevention.

3. What component should be included in the nutritional management of a child with Crohn's disease?

• A. High fiber
• B. Increased protein
• C. Reduced calories
• D. Herbal supplements

Correct answer: B

Rationale: The correct answer is B: Increased protein. Children with Crohn's disease require a diet high in protein to support growth and tissue repair. High fiber should be avoided as it can exacerbate symptoms of Crohn's disease. Reducing calories can lead to malnutrition, which is detrimental in this condition. Herbal supplements should be used cautiously and only under medical advice as they may interact with medications or worsen symptoms.

4. What laboratory finding should the nurse expect in a child with an excess of water?

• A. Decreased hematocrit
• B. High serum osmolality
• C. High urine specific gravity
• D. Increased blood urea nitrogen (BUN)

Correct answer: A

Rationale: Water excess typically leads to hemodilution, resulting in a decreased hematocrit. High serum osmolality and specific gravity would indicate dehydration, while elevated BUN could suggest renal impairment or dehydration, not fluid overload.

5. Which finding suggests fluid volume deficit in an infant presenting with vomiting and diarrhea for 2 days?

• A. Increased blood pressure
• B. A sunken fontanel
• C. Decreased pulse rate
• D. Low urine specific gravity

Correct answer: B

Rationale: A sunken fontanel is a classic sign of dehydration in infants, indicating a fluid volume deficit. In dehydration, the fontanel sinks due to decreased fluid volume in the body. Increased blood pressure (Choice A) is not typically associated with dehydration in infants. Decreased pulse rate (Choice C) is not a common finding in fluid volume deficit, as the body tries to increase the heart rate to compensate for decreased volume. Low urine specific gravity (Choice D) may be seen in dehydration, but it is not as specific or as easily observable as a sunken fontanel.

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