Nursing Elites

1. What findings would the nurse consider normal in assessing the anterior fontanel of a neonate?

• A. Closed anterior fontanel
• B. Sunken anterior fontanel
• C. Bulging anterior fontanel
• D. Pulsating anterior fontanel

Correct answer: D

Rationale: The correct answer is D: Pulsating anterior fontanel. The fontanel should feel flat, firm, and well demarcated. Pulsations are frequently visible at the anterior fontanel, which is a normal finding in a neonate. A closed anterior fontanel, as mentioned, is a potential sign of a major abnormality. A sunken or bulging fontanel (when the infant is quiet) may be indicative of distress or a major abnormality. Therefore, options A, B, and C are considered abnormal findings when assessing the anterior fontanel of a neonate.

2. What is the most critical physiologic change required of newborns at birth?

• A. Transition from fetal to neonatal breathing
• B. Body temperature maintenance
• C. Stabilization of fluid and electrolytes
• D. Closure of fetal shunts in the heart

Correct answer: A

Rationale: The correct answer is A: Transition from fetal to neonatal breathing. The onset of breathing is the most immediate and critical physiologic change required for the transition to extrauterine life. Factors that interfere with this normal transition increase fetal asphyxia, which is a condition of hypoxemia, hypercapnia, and acidosis. While body temperature maintenance, stabilization of fluid and electrolytes, and closure of fetal shunts in the heart are crucial changes in the transition to extrauterine life, breathing and the exchange of oxygen for carbon dioxide must take precedence as they are essential for newborn survival.

3. What is the primary symptom of congenital diaphragmatic hernia in a newborn?

• A. Cyanosis
• B. Bradycardia
• C. Absent breath sounds
• D. Tachypnea

Correct answer: C

Rationale: Absent breath sounds on the affected side are a primary symptom of congenital diaphragmatic hernia. Cyanosis, bradycardia, and tachypnea may also be present but are not the primary symptom. Cyanosis is a bluish discoloration of the skin due to poor oxygenation, bradycardia is a slower than normal heart rate, and tachypnea is rapid breathing.

4. A nurse must do a venipuncture on a 6-year-old child. What consideration is important in providing atraumatic care?

• A. Use an 18-gauge needle if possible.
• B. Show the child the equipment to be used before the procedure.
• C. If not successful after four attempts, have another nurse try.
• D. Restrain the child completely.

Correct answer: B

Rationale: Showing the child the equipment before the procedure helps build trust and reduces fear. Using an 18-gauge needle is too large for a child, and multiple attempts can increase trauma. Restraining completely can increase fear and anxiety.

5. A 14-month-old child is admitted to the hospital with laryngotracheobronchitis (LTB). Which assessment findings should the nurse expect?

• A. Cyanosis and dyspnea
• B. Productive cough and high fever
• C. Barking cough and inspiratory stridor
• D. Pale laryngeal and dyspnea

Correct answer: C

Rationale: The correct answer is C: 'Barking cough and inspiratory stridor.' Classic signs of laryngotracheobronchitis (LTB) include a barking cough, often described as a seal-like cough, and inspiratory stridor, which is a high-pitched sound heard during inspiration. These symptoms occur due to inflammation and narrowing of the upper airway. Choices A, B, and D are incorrect as they do not align with the typical assessment findings of LTB. Cyanosis and dyspnea (Choice A) may occur in severe cases but are not specific to LTB. Productive cough and high fever (Choice B) are more indicative of lower respiratory tract infections. Pale laryngeal and dyspnea (Choice D) are not characteristic findings of LTB.

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