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. What is the appropriate placement of a tongue blade for assessment of the mouth and throat?

• A. On the lower jaw
• B. Side of the tongue
• C. Against the soft palate
• D. Center back area of the tongue

Correct answer: B

Rationale: The side of the tongue is the appropriate place for a tongue blade to avoid triggering the gag reflex during assessment of the mouth and throat.

3. When should a child receive the first dose of the hepatitis B virus (HBV) vaccine if the mother is hepatitis B surface antigen (HBsAg) negative?

• A. 2 months of age, before hospital discharge.
• B. Birth before discharge from the hospital.
• C. 6 months of age, at the third well-child visit.
• D. No time (this vaccine is not currently recommended).

Correct answer: B

Rationale: If the mother is HBsAg negative, it is recommended that the child receives the first dose of the hepatitis B vaccine at birth before discharge from the hospital. This is to provide early protection against the hepatitis B virus. The second dose of the vaccine is typically given at the first well-child visit, and the third dose is usually administered at a later date. The Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention and the Committee on Infectious Diseases of the American Academy of Pediatrics govern the recommendations for immunization, including the hepatitis B virus vaccine. Choice A is incorrect as the first dose should ideally be given at birth. Choice C is incorrect as waiting until 6 months of age may leave the child vulnerable to infection during the early months of life. Choice D is incorrect as the hepatitis B vaccine is recommended for all newborns, especially if the mother is HBsAg negative, to prevent transmission of the virus.

4. Prior to giving a hospitalized pre-schooler an injection, the nurse gives the child’s teddy bear a “shot” first. This method is known as:

• A. Critical play
• B. Role play
• C. Diversionary activity
• D. Dramatic play

Correct answer: D

Rationale: The correct answer is D: Dramatic play. Dramatic play involves children acting out experiences to better understand them and reduce fear. In this scenario, by giving the teddy bear a 'shot' first, the nurse is engaging in dramatic play to help the child comprehend and feel more comfortable with the upcoming injection.\n A: Critical play involves critical thinking and problem-solving, not acting out scenarios.\n B: Role play typically involves pretending to be someone else, not necessarily acting out a specific experience.\n C: Diversionary activity aims to distract or redirect attention, which is different from the purpose of dramatic play in this context.

5. A four-year-old child has a history of repeated otitis media despite antibiotic treatment. Which treatment measure should the nurse discuss with the parents?

• A. Antibiotic treatment
• B. Adenoidectomy
• C. The insertion of tympanostomy (pressure equalizing) tubes
• D. Tonsillectomy

Correct answer: C

Rationale: The correct answer is C: The insertion of tympanostomy (pressure equalizing) tubes. This treatment measure is appropriate for a child with recurrent otitis media as it helps drain fluid from the middle ear and prevent further infections. Adenoidectomy (choice B) involves the removal of the adenoids, which may not directly address the ear infections. Antibiotic treatment (choice A) has already been ineffective in this case, so alternative measures are necessary. Tonsillectomy (choice D) is not typically indicated for otitis media unless there are specific reasons such as enlarged tonsils contributing to the condition.

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