Nursing Elites

1. What should the nurse recommend to reduce the risk of sudden infant death syndrome (SIDS) in a 6-month-old infant?

• A. Place the infant on their back to sleep
• B. Use a pacifier during sleep
• C. Have the infant sleep on their side
• D. Keep the infant's room cool

Correct answer: A

Rationale: Placing the infant on their back to sleep is the correct recommendation to reduce the risk of sudden infant death syndrome (SIDS). This sleep position has been shown to significantly decrease the incidence of SIDS. Using a pacifier during sleep (Choice B) can also help reduce the risk, but it is secondary to the back sleeping position. Having the infant sleep on their side (Choice C) is not recommended, as it increases the risk of SIDS. Keeping the infant's room cool (Choice D) may provide a comfortable sleeping environment but does not directly reduce the risk of SIDS.

2. A child undergoes heart surgery to repair the defects associated with tetralogy of Fallot. What behavior is essential for the nurse to prevent postoperatively?

• A. Crying
• B. Coughing
• C. Straining at stool
• D. Unnecessary movement

Correct answer: C

Rationale: The correct behavior that the nurse needs to prevent postoperatively is straining at stool. Straining at stool should be avoided as it can increase intrathoracic pressure, leading to stress on the surgical site. This stress can potentially compromise the surgical repair and increase the risk of complications. Crying, coughing, and unnecessary movement, although important to monitor postoperatively, do not directly impact the surgical site as significantly as straining at stool does. Therefore, the focus should be on preventing straining at stool to ensure the best postoperative outcome for the child.

3. What is an important nursing consideration for a child with a diagnosis of juvenile idiopathic arthritis (JIA) being treated with methotrexate?

• A. Monitor liver function tests regularly
• B. Encourage regular exercise
• C. Provide high-calorie snacks
• D. Encourage frequent handwashing

Correct answer: A

Rationale: Monitoring liver function tests regularly is crucial when a child with JIA is on methotrexate due to the potential hepatotoxicity associated with this medication. Methotrexate can lead to liver damage, hence monitoring helps in early detection and intervention. Encouraging regular exercise (Choice B) is generally good for children with JIA to maintain joint mobility and muscle strength, but it is not directly related to methotrexate therapy. Providing high-calorie snacks (Choice C) is not a priority consideration for a child on methotrexate. Encouraging frequent handwashing (Choice D) is important for infection control, but it is not specifically associated with methotrexate therapy in a child with JIA.

4. 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 is problematic because children with acyanotic heart defects may develop cyanosis, complicating the differentiation between acyanotic and cyanotic defects. Choice A is incorrect because the system is not solely based on explaining hemodynamics. Choice B is incorrect because the classification is not based on the ease of identifying children with cyanotic defects. Choice C is incorrect because cyanosis can indeed be present in children with congenital heart defects, especially acyanotic defects that may lead to cyanosis under certain circumstances.

5. Which best describes a full-thickness (third-degree) burn?

• A. Erythema and pain
• B. Skin showing erythema followed by blister formation
• C. Destruction of all layers of skin evident with extension into subcutaneous tissue
• D. Destruction injury involving underlying structures such as muscle, fascia, and bone

Correct answer: C

Rationale: The correct answer is C: Full-thickness burns involve the destruction of all layers of skin, extending into the subcutaneous tissue. This type of burn causes severe damage and loss of sensation due to nerve destruction. Choice A, erythema and pain, describes superficial burns (first-degree). Choice B, skin showing erythema followed by blister formation, describes partial-thickness burns (second-degree). Choice D, destruction injury involving underlying structures such as muscle, fascia, and bone, goes beyond the description of full-thickness burns.

Similar Questions