Nursing Elites

1. During the initial assessment of the newborn, which of the following data would be considered normal?

• A. Chest circumference 31.5 cm, head circumference 33.5 cm
• B. Chest circumference 30 cm, head circumference 29 cm
• C. Chest circumference 38 cm, head circumference 31.5 cm
• D. Chest circumference 32.5 cm, head circumference 36 cm

Correct answer: A

Rationale: The correct answer is A. During the initial assessment of a newborn, the average head circumference at birth is 32 to 37 cm, while the average chest circumference ranges from 30 to 35 cm. Normally, the head's circumference is about 2 cm greater than the chest circumference at birth. Choice A provides measurements of chest circumference 31.5 cm and head circumference 33.5 cm, both falling within the normal range in terms of actual size and relative size. Choices B, C, and D do not align with the typical measurements seen in a healthy newborn. Choice B has both circumferences below the average range, choice C has the chest circumference above the average, and choice D has the head circumference notably higher than the chest circumference, which is not typical for a newborn.

2. During the pediatric assessment process, which scenario would be the LEAST appropriate for the transition phase?

• A. A parent is available to help keep the child calm.
• B. The child is unstable and needs rapid transport.
• C. You determine that the child's condition is stable.
• D. Your transport time is greater than 30 minutes.

Correct answer: B

Rationale: During a pediatric assessment, the transition phase is a critical period where care is handed over from prehospital providers to the hospital team. If the child is unstable and requires rapid transport, it is not appropriate to delay for a transition phase. In such cases, immediate transport to a higher level of care is paramount to ensure the child's safety and well-being. Choice A is appropriate as having a parent present can help keep the child calm during the transition. Choice C is also appropriate as transitioning a stable child allows for a smoother handover. Choice D, while indicating a longer transport time, does not necessarily affect the need for a transition phase as long as the child's condition remains stable.

3. A child of 3 years has been admitted to your pediatric ward. The doctor gave a provisional diagnosis of respiratory tract infection. After careful assessment and history, he gave a final diagnosis of lower respiratory infection. Which of the following signs will confirm the diagnosis?

• A. Cough
• B. Fever
• C. Inability to lie supine
• D. Inability to eat

Correct answer: C

Rationale: Inability to lie supine is a specific sign of lower respiratory infection. This condition can cause discomfort or difficulty in breathing when lying flat, leading to a preference for an upright or semi-upright position. While cough and fever are common symptoms of respiratory infections, the inability to lie supine is more indicative of lower respiratory involvement.

4. Upon delivery of a baby's head, you see that the umbilical cord is wrapped around its neck. Initial treatment for this condition should include:

• A. Clamping and cutting the umbilical cord.
• B. Gently pulling on the cord to facilitate removal.
• C. Trying to remove the cord from around the neck.
• D. Keeping the cord moist and providing rapid transport.

Correct answer: C

Rationale: When encountering a situation where the umbilical cord is wrapped around a baby's neck upon delivery, the initial treatment should involve trying to remove the cord from around the neck gently. It is crucial to handle this situation delicately to avoid causing harm to the baby. Attempting to ease the cord over the baby's head without pulling or tightening can help prevent potential complications associated with cord compression. Choice A, clamping and cutting the umbilical cord, is not recommended as it can lead to abrupt deprivation of oxygen to the baby. Choice B, gently pulling on the cord, can worsen the situation by tightening the cord around the baby's neck. Choice D, keeping the cord moist and providing rapid transport, is not the immediate concern and does not address the potential risks of cord compression during delivery. Therefore, the priority is to carefully attempt to remove the cord from around the baby's neck to ensure a safe delivery.

5. A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:

• A. a normal pregnancy.
• B. a ruptured ovarian cyst.
• C. an ectopic pregnancy.
• D. a spontaneous abortion.

Correct answer: C

Rationale: Severe lower abdominal pain, light vaginal bleeding, and a history of missed periods are concerning for an ectopic pregnancy. The absence of a normal menstrual period along with these symptoms raises suspicion for an ectopic pregnancy, which requires immediate medical attention due to the risk of rupture and life-threatening complications. A normal pregnancy would typically present with different symptoms such as a positive pregnancy test and typical signs of early pregnancy. A ruptured ovarian cyst may present with similar symptoms but typically lacks the history of missed periods. A spontaneous abortion usually involves heavier bleeding and tissue passage, which is not described in this scenario.

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