Nursing Elites

1. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

• A. Your child probably had a crisis, and you were unaware of the symptoms.
• B. Are you sure your child has sickle cell anemia and not sickle cell trait?
• C. Affected children can be asymptomatic in early infancy because of high levels of fetal hemoglobin that inhibit sickling.
• D. Have you asked your doctor about this yet?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

2. The nurses caring for a child are concerned about the child’s frequent requests for pain medication. During a team conference, a new nurse suggests they consider administering a placebo instead of the usual pain medication to see how the child responds. The team educates the nurse on why this is not appropriate and bases the decision on what knowledge?

• A. This practice is unjustified and unethical.
• B. This practice is effective in determining whether a child’s pain is real.
• C. The absence of a response to a placebo means the child’s pain has an organic basis.
• D. A positive response to a placebo will not occur if the child’s pain has an organic basis.

Correct answer: A

Rationale: The correct answer is A. The use of placebos without the patient’s consent is unethical and goes against the principles of beneficence and autonomy. Choice B is incorrect because using placebos does not provide reliable information about the presence or severity of the pain; it only indicates the response to the placebo itself. Choice C is wrong as the absence of a response to a placebo does not definitively mean that the child’s pain has an organic basis; there could be various reasons for the lack of response. Choice D is also incorrect as individuals may have a positive response to a placebo even if their pain has a significant organic cause. Therefore, the most appropriate response is A, emphasizing the ethical concerns surrounding the use of placebos without informed consent.

3. An infant requires surgery for repair of a cleft lip. An important priority of the preoperative nursing care is which?

• A. Initiating discharge teaching
• B. Performing baseline physical and behavioral assessment
• C. Observing for allergic reactions to preoperative antibiotics
• D. Determining whether this defect exists in other family members

Correct answer: B

Rationale: Performing a baseline physical and behavioral assessment is crucial to determine the infant's current health status and to identify any potential risks before surgery.

4. What tool would be most useful to assess maternal and newborn attachment behaviors?

• A. Apgar
• B. Ballard scale
• C. NCAST (Nursing Child Assessment Satellite Training) Feeding Scale
• D. Brazelton Neonatal Behavioral Assessment Scale

Correct answer: C

Rationale: The NCAST Feeding Scale is the most suitable tool to evaluate maternal and newborn attachment behaviors during feedings. It focuses on observing the interaction between the parent and infant, providing insights into their bonding. The Apgar score is used to assess a neonate's immediate transition to life outside the womb, not specifically maternal and newborn attachment behaviors. The Ballard scale is used to estimate gestational age, not to assess attachment behaviors. The Brazelton Neonatal Behavioral Assessment Scale is designed to evaluate a newborn's responses to various stimuli, not specifically maternal and newborn attachment behaviors.

5. The parent of an 8.2-kg (18-lb) 9-month-old infant is borrowing a federally approved car seat from the clinic. The nurse should explain that the safest way to put in the car seat is what?

• A. Front facing in back seat
• B. Rear facing in back seat
• C. Front facing in front seat with air bag on passenger side
• D. Rear facing in front seat if an air bag is on the passenger side

Correct answer: B

Rationale: Infants should be placed rear-facing in the back seat until they are at least 2 years old or exceed the weight/height limit of their car seat for optimal safety.

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