Nursing Elites

1. Use this scenario to answer questions 70 to 72. Madam KK brought her two-month-old sick child to your facility. She complains that the child is having a fever, fast breathing, and is not eating anything. Using the IMNCI, what will be the steps to manage this child?

• A. i. Provide practical treatment instructions
• B. ii. Triage based on the severity of illness
• C. iii. Perform a head-to-toe assessment
• D. iv. Identify specific treatments

Correct answer: D

Rationale: To manage the sick child using IMNCI, the correct steps are as follows: Triage based on the severity of illness, Perform a head-to-toe assessment, Identify specific treatments, Provide practical treatment instructions, and Assess feeding while providing counseling. The correct answer, 'D,' focuses on identifying specific treatments, which is crucial in addressing the child's condition effectively. Choice A ('Provide practical treatment instructions') is not the initial step and should come after identifying specific treatments. Choice B ('Triage based on the severity of illness') and Choice C ('Perform a head-to-toe assessment') are essential steps but should follow the identification of specific treatments in the IMNCI approach.

2. What is the aim of Integrated Management of neonatal and Childhood Illnesses?

• A. Improved case management
• B. Improved family and community practices
• C. None of the above
• D. A & B

Correct answer: D

Rationale: The aim of the Integrated Management of neonatal and Childhood Illnesses is to enhance both case management and family and community practices. By improving case management, healthcare providers can ensure appropriate treatment and care, leading to better outcomes for neonates and children. Enhancing family and community practices can contribute to the prevention, early detection, and overall well-being of children. Choice A is incorrect as the aim is not solely focused on improved case management. Choice B is incorrect as the aim goes beyond just improving family and community practices. Choice C is incorrect as the correct aim involves both improved case management and family/community practices, making choice D the most comprehensive and accurate answer.

3. The healthcare provider is assessing a newborn who had undergone vaginal delivery. Which of the following findings is least likely to be observed in a normal newborn?

• A. (+) Moro reflex
• B. Heart rate is 80 bpm
• C. Respirations are irregular
• D. Uneven head shape

Correct answer: B

Rationale: A heart rate of 80 bpm is least likely to be observed in a normal newborn. The normal heart rate range for a newborn is usually higher than 80 bpm, typically ranging from 120-160 bpm. The Moro reflex (choice A) is a normal newborn reflex, respirations being irregular (choice C) are expected due to the immature respiratory control center, and an uneven head shape (choice D) is common due to molding during vaginal delivery.

4. What is the appropriate treatment for a responsive 4-year-old child with a mild airway obstruction, respiratory distress, a strong cough, and normal skin color?

• A. Oxygen, back slaps, and transport.
• B. Subdiaphragmatic thrusts until the object is expelled.
• C. Assisted ventilations, back slaps, and transport.
• D. Supplemental oxygen and transport.

Correct answer: D

Rationale: For a responsive 4-year-old child with a mild airway obstruction, respiratory distress, a strong cough, and normal skin color, the appropriate treatment includes providing supplemental oxygen and arranging for transport to a healthcare facility. Oxygen helps alleviate the respiratory distress, and transport ensures the child receives further evaluation and care by healthcare professionals. Back slaps and subdiaphragmatic thrusts are not recommended for a child with a mild airway obstruction and normal skin color, as these interventions are typically reserved for more severe cases of airway obstruction.

5. A breastfeeding mother reports to the nurse that her newborn nurses every hour and never seems satisfied. Which advice should the nurse provide?

• A. Supplement breastfeeding with formula after each nursing session.
• B. Allow the newborn to nurse on each breast for at least 20 minutes.
• C. Reduce the number of nursing sessions to every 2-3 hours.
• D. Ensure the newborn has a proper latch and is effectively nursing.

Correct answer: D

Rationale: The nurse should ensure that the newborn has a proper latch and is effectively nursing. Sometimes, newborns nurse frequently for comfort even when they are effectively latched. It is essential to address the latch first before considering other interventions. Supplementing with formula (Choice A) may decrease the mother's milk supply. Allowing the newborn to nurse for a set time (Choice B) may not address the underlying latch issue. Reducing nursing sessions (Choice C) may lead to decreased milk production and does not address the latch problem.

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