Nursing Elites

1. What interventions should be implemented to maintain the skin integrity of a preterm infant born at 30 weeks?

• A. Avoid cleaning the skin
• B. Bathe the infant with sterile water
• C. Cleanse the skin with a gentle alkaline-based soap and water
• D. Thoroughly rinse the skin with plain water after bathing

Correct answer: B

Rationale: The correct intervention to maintain the skin integrity of a preterm infant born at 30 weeks is to bathe the infant with sterile water. Bathing with sterile water or a neutral pH solution is recommended to protect the delicate skin of preterm infants, which is more permeable and prone to damage. Choices A, C, and D are incorrect as avoiding cleaning the skin may lead to hygiene issues, cleansing with alkaline-based soap can be harsh on the delicate skin, and thoroughly rinsing with plain water after bathing may not be as gentle and protective for preterm infants.

2. One of the most critical needs of the infant is control of body temperature. The nurse caring for a newborn warms all equipment that comes in direct contact with the newborn to help prevent which type of heat loss?

• A. Convection
• B. Evaporation
• C. Conduction
• D. Radiation

Correct answer: C

Rationale: The correct answer is Conduction (choice C). Conduction heat loss occurs when the newborn’s skin comes into direct contact with a cooler surface, so warming equipment helps prevent this. Choice A, Convection, is the transfer of heat through air or water currents, not direct contact. Choice B, Evaporation, is the loss of heat through moisture on the skin evaporating, not direct contact. Choice D, Radiation, is the transfer of heat in the form of waves or particles, not direct contact.

3. A 12-month-old infant has been diagnosed with failure to thrive (FTT). Which assessment findings does the nurse expect to be documented with this infant?

• A. Fear of strangers
• B. Minimal smiling
• C. Avoidance of eye contact
• D. All of the above

Correct answer: D

Rationale: These behaviors are consistent with FTT and indicate social withdrawal, which is often observed in infants who are not thriving. A wide-eyed gaze and avoidance of eye contact can also indicate developmental delays or emotional disturbances.

4. The LPN is caring for a 1-month-old patient post-surgery. Which pain scale is expected to be used to evaluate post-op pain?

• A. Oucher
• B. Wong-Baker FACES
• C. FLACC
• D. 0-10 pain scale

Correct answer: C

Rationale: The FLACC (Face, Legs, Activity, Cry, Consolability) scale is commonly used to assess pain in infants and young children who are unable to verbally communicate their pain. This scale is particularly useful in assessing post-operative pain in infants as it evaluates different behaviors and physiological responses to pain. The Oucher scale is more commonly used with children who are older and can provide self-report of pain intensity. Wong-Baker FACES scale is primarily used with children who are older and can indicate their pain level by pointing to facial expressions. The 0-10 pain scale is typically used with older children and adults who can rate their pain on a numerical scale.

5. When doing a nutritional assessment on a Hispanic family, the nurse learns that their diet consists mainly of vegetables, legumes, and starches. The nurse should recognize that this diet is which?

• A. Lacking in protein
• B. Indicating they live in poverty
• C. Providing sufficient amino acids
• D. Needing enrichment with meat and milk

Correct answer: C

Rationale: A diet rich in vegetables, legumes, and starches can provide sufficient amino acids, particularly when complemented with varied food sources to ensure a balanced intake of essential nutrients.

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