Nursing Elites

1. The school nurse is caring for a boy with hemophilia who fell on his arm during recess. What supportive measures should the nurse use until factor replacement therapy can be instituted?

• A. Apply warm, moist compresses
• B. Apply pressure for at least 1 minute
• C. Elevate the area above the level of the heart
• D. Begin passive range-of-motion unless the pain is severe

Correct answer: C

Rationale: The correct supportive measure for the school nurse to use for a boy with hemophilia who fell on his arm during recess is to elevate the area above the level of the heart. Elevating the affected area helps reduce bleeding and swelling in a child with hemophilia until factor replacement therapy can be provided. Applying warm, moist compresses (Choice A) may worsen bleeding by dilating blood vessels. Applying pressure for at least 1 minute (Choice B) is not recommended for hemophilia as it can lead to increased bleeding. Beginning passive range-of-motion (Choice D) should be avoided as it can exacerbate bleeding and further injury in a child with hemophilia.

2. Why should a nurse plan an evening snack for a child receiving Novolin N insulin?

• A. To encourage the child to adhere to the diet.
• B. To provide energy for immediate use.
• C. To help the child gain weight with extra calories.
• D. To counteract late insulin activity with nourishment.

Correct answer: D

Rationale: The correct answer is D. Novolin N insulin peaks in the evening, which can lead to hypoglycemia during the night. Providing an evening snack helps to counteract the late insulin activity and prevent hypoglycemia. Choice A is incorrect because the primary reason for the evening snack is not to encourage adherence to the diet. Choice B is incorrect as the snack is not primarily for immediate energy use. Choice C is incorrect as the goal of the snack is not to help the child gain weight but to manage blood sugar levels.

3. A 4-year-old child is brought to the emergency department with a suspected fracture. What is the priority nursing action?

• A. Immobilize the affected limb
• B. Apply ice to the affected area
• C. Elevate the affected limb
• D. Check the child's neurovascular status

Correct answer: A

Rationale: The priority nursing action when a child with a suspected fracture is brought to the emergency department is to immobilize the affected limb. Immobilization helps prevent further injury until a fracture is confirmed or ruled out. Applying ice or elevating the limb may be necessary interventions but should come after immobilizing the limb. Checking the child's neurovascular status is important but should follow immobilization to ensure no further harm is done during the assessment.

4. A newborn with an anorectal anomaly had an anoplasty performed. At the 2-week follow-up visit, a series of anal dilations are begun. What should the nurse recommend to the parents to help prevent the infant from becoming constipated?

• A. Use a soy formula.
• B. Breastfeed if possible.
• C. Administer a suppository nightly.
• D. Offer glucose water between feedings.

Correct answer: B

Rationale: Breastfeeding is the best recommendation to help prevent constipation in infants. Breast milk is easily digestible and contains the right balance of nutrients, which can lead to softer stools, thus reducing the likelihood of constipation. Offering a soy formula (Choice A) may not necessarily prevent constipation as effectively as breast milk due to differences in nutrient composition. Administering a suppository nightly (Choice C) is not a routine measure for preventing constipation in infants and may not be suitable for regular use in this scenario. Offering glucose water (Choice D) between feedings is not recommended as it does not provide the necessary nutrients found in breast milk, which are essential for preventing constipation and promoting overall health in newborns.

5. A home care nurse is visiting a family for the first time. The 4-week-old infant had surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired, and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

• A. “Tell me about your daily routine.”
• B. “You look tired. Is everything all right?”
• C. “When was the last time the baby had a bottle?”
• D. “Oh, it looks like you two are having a bad day.”

Correct answer: A

Rationale: The most appropriate statement by the nurse in this scenario is to inquire about the family's daily routine. This question allows the nurse to gather information about the family dynamics, the care routine for the infant post-surgery, feeding schedules, and potential stressors. It opens the conversation in a non-intrusive manner and helps the nurse assess the family's situation to provide appropriate support. Choices B, C, and D do not address the situation effectively. Asking about the daily routine is crucial for the nurse to understand the family's needs and offer targeted assistance.

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