Nursing Elites

1. The nurse is preparing to administer vitamin K to a newborn. The mother asks why this injection is necessary. What is the nurse's best response?

• A. It helps the baby's liver function properly.
• B. It prevents bleeding disorders in the newborn.
• C. It boosts the baby's immune system.
• D. It promotes the baby's growth and development.

Correct answer: B

Rationale: The correct answer is B. Vitamin K is administered to newborns to prevent bleeding disorders since they have low levels of vitamin K, which is essential for blood clotting. By providing this injection, the nurse ensures that the newborn has an adequate supply of vitamin K to support proper blood clotting and prevent potential bleeding complications. Choices A, C, and D are incorrect because vitamin K's primary role in newborns is related to blood clotting and preventing bleeding, not liver function, immune system, or growth and development.

2. You are dispatched to a residence for a 4-year-old female who is sick. Your assessment reveals that she has increased work of breathing and is making a high-pitched sound during inhalation. Her mother tells you that she has been running a high fever for the past 24 hours. Your MOST immediate concern should be:

• A. determining if the child has a history of croup.
• B. preparing to treat her for a febrile seizure.
• C. assessing the need for ventilation assistance.
• D. taking her temperature to see how high it is.

Correct answer: C

Rationale: In a child with increased work of breathing, a high-pitched sound during inhalation, and a high fever, upper airway obstruction should be suspected. The child's condition may require immediate ventilation assistance to ensure adequate oxygenation and ventilation. Therefore, the most immediate concern in this scenario is to assess the need for ventilation assistance.

3. What characteristic indicates that a mass on a newborn's head is a cephalohematoma?

• A. The mass appears on the second day after birth.
• B. The mass grows larger when the newborn cries.
• C. The head appears asymmetrical.
• D. The mass is located on only one side of the head.

Correct answer: A

Rationale: A cephalohematoma typically appears between the first and second days after birth, making choice A the correct answer. It results from blood vessel rupture between a cranial bone and the periosteal membrane. Choices B, C, and D are incorrect because the growth of the mass when the newborn cries, asymmetrical head appearance, or the mass being located on only one side of the head are not specific indicators of a cephalohematoma.

4. A breastfeeding mother is experiencing nipple pain. What should the nurse instruct her to do?

• A. Use soap and water to clean her nipples
• B. Apply warm compresses to her breasts
• C. Ensure the baby is latching on properly
• D. Limit breastfeeding to every 4 hours

Correct answer: C

Rationale: When a breastfeeding mother experiences nipple pain, ensuring the baby latches on properly is essential. Proper latch-on technique can help prevent and alleviate nipple pain by ensuring the baby is effectively extracting milk and not causing undue pressure or friction on the nipple. This guidance can promote a more comfortable breastfeeding experience for the mother and improve milk transfer for the baby.

5. What is the MOST common cause of shock in infants and children?

• A. Severe allergic reaction
• B. Dehydration
• C. Accidental poisoning
• D. Cardiac failure

Correct answer: B

Rationale: Dehydration is the most common cause of shock in infants and children. In children, the body's fluid reserves are smaller compared to adults, making them more susceptible to dehydration, which can lead to shock if not promptly addressed. Severe allergic reactions, accidental poisoning, and cardiac failure can also cause shock, but dehydration is the most frequent cause in this age group.

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