Nursing Elites

1. What is important to include in discharge instructions for parents of a child who has had a tonsillectomy?

• A. Encourage the child to gargle with salt water
• B. Encourage fluid intake
• C. Provide the child with hard candy
• D. Apply heat to the neck

Correct answer: B

Rationale: Encouraging fluid intake is essential in the discharge instructions for a child who has had a tonsillectomy. It helps keep the throat moist, aids in preventing dehydration, and promotes healing. Gargling with salt water is not typically recommended after a tonsillectomy as it may irritate the surgical site. Providing the child with hard candy is not advisable as it can irritate the throat and potentially cause harm. Applying heat to the neck is also not recommended post-tonsillectomy as it can increase swelling and discomfort in the surgical area.

2. Congenital heart defects have traditionally been divided into acyanotic or cyanotic defects. Based on the nurse’s knowledge of congenital heart defects, this system in clinical practice is

• A. helpful because it explains the hemodynamics involved
• B. helpful because children with cyanotic defects are easily identified
• C. problematic because cyanosis is rarely present in children
• D. problematic because children with acyanotic heart defects may develop cyanosis

Correct answer: D

Rationale: The classification system of congenital heart defects into acyanotic or cyanotic defects is problematic because children with acyanotic heart defects may develop cyanosis, complicating the differentiation. Cyanosis can occur in some acyanotic defects due to various reasons such as right-to-left shunting or decreased pulmonary blood flow, making the classification based solely on cyanosis misleading. Choice A is incorrect because while the classification may involve hemodynamics, the main issue lies in the potential for acyanotic defects to develop cyanosis. Choice B is incorrect as the ease of identifying children with cyanotic defects does not address the main problem with the classification system. Choice C is also incorrect as the presence of cyanosis is not the only factor determining the classification's validity.

3. After surgery to correct hypertrophic pyloric stenosis (HPS) in a 3-week-old infant who had been formula-fed, which postoperative feeding order is appropriate?

• A. Thickened formula 24 hours after surgery
• B. Withholding feedings for the first 24 hours
• C. Regular formula feeding within 24 hours after surgery
• D. Additional glucose feedings as desired after the first 24 hours

Correct answer: C

Rationale: After surgery for hypertrophic pyloric stenosis (HPS), it is appropriate to resume regular formula feeding within 24 hours postoperatively to promote recovery. Choice A, thickened formula after surgery, may be too heavy for the infant's digestive system at this early stage. Withholding feedings for the first 24 hours (Choice B) is not recommended as early feeding helps with recovery. Additional glucose feedings (Choice D) are not necessary and may not provide the balanced nutrition required after surgery.

4. When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include?

• A. Administration of colloid initially followed by a crystalloid
• B. Determination of fluid replacement based on the type of burn
• C. Administration of most of the volume during the first 8 hours
• D. Monitoring of hourly urine output to achieve less than 1 mL/kg/hr

Correct answer: C

Rationale: The correct answer is C. In fluid replacement therapy for burns, it is crucial to administer most of the volume during the first 8 hours to prevent shock and maintain perfusion. This rapid administration is essential to stabilize the child's condition. Choices A and B are incorrect because the initial fluid replacement in burns typically involves administering crystalloids, not colloids, and the fluid replacement is generally calculated based on the extent of the burn injury, not the type of burn. Choice D is incorrect as monitoring hourly urine output to achieve less than 1 mL/kg/hr is not recommended in burn patients; instead, urine output should be monitored to achieve 1-2 mL/kg/hr in children to ensure adequate renal perfusion.

5. A parent calls the clinic because their child has ingested a small amount of household bleach. What should the nurse advise?

• A. Administer activated charcoal
• B. Induce vomiting immediately
• C. Call the poison control center
• D. Take the child to the emergency department

Correct answer: C

Rationale: In the case of a child ingesting household bleach, the primary advice should be to call the poison control center (Choice C). The poison control center can provide specific guidance on how to manage the ingestion, including whether any immediate interventions are necessary. Administering activated charcoal (Choice A) or inducing vomiting immediately (Choice B) can worsen the situation as they are not recommended treatments for bleach ingestion. Taking the child to the emergency department (Choice D) may be necessary depending on the advice given by the poison control center, but the initial step should be to seek guidance from the experts at the poison control center.

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