Nursing Elites

1. What is the most common symptom of gastroesophageal reflux in infants?

• A. Projectile vomiting
• B. Bilious vomiting
• C. Frequent spitting up
• D. Diarrhea

Correct answer: C

Rationale: Frequent spitting up is indeed a common symptom of gastroesophageal reflux in infants. It is caused by the backward flow of stomach contents into the esophagus, leading to infants regurgitating milk or formula shortly after feeding. Projectile vomiting (choice A) is more commonly associated with conditions like pyloric stenosis rather than gastroesophageal reflux. Bilious vomiting (choice B) often indicates an obstruction in the gastrointestinal tract. Diarrhea (choice D) is not typically a primary symptom of gastroesophageal reflux in infants.

2. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include?

• A. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
• B. Hold the infant in the prone position after a feeding.
• C. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
• D. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Correct answer: D

Rationale: Cimetidine is an H2 blocker that reduces stomach acid, helping manage GER. Holding the infant in the prone position is not recommended due to the risk of SIDS. Breastfeeding should not be discontinued unless advised by a physician. Elevating the head to 90 degrees is excessive.

3. What is the purpose of using cimetidine (Tagamet) for gastroesophageal reflux?

• A. The medication reduces gastric acid secretion.
• B. The medication neutralizes the acid in the stomach.
• C. The medication increases the rate of gastric emptying time.
• D. The medication coats the lining of the stomach and esophagus.

Correct answer: A

Rationale: The correct answer is A. Cimetidine (Tagamet) is an H2 receptor antagonist that works by reducing gastric acid secretion. This action helps to decrease the acidity in the stomach, which in turn reduces the symptoms of gastroesophageal reflux. Choice B is incorrect because cimetidine does not neutralize acid but rather decreases its production. Choice C is incorrect as cimetidine does not affect the rate of gastric emptying time. Choice D is incorrect as cimetidine does not coat the lining of the stomach and esophagus but instead works to reduce gastric acid secretion.

4. Parents of a child who will need hemodialysis ask the nurse, What are the advantages of a fistula over a graft or external access device for hemodialysis? (Select all that apply.)

• A. It is ready to be used immediately.
• B. All below
• C. There is less restriction of activity with a fistula.
• D. It produces dilation and thickening of the superficial vessels.

Correct answer: A

Rationale: A fistula typically has fewer complications, allows for greater freedom of movement, and involves natural vessel changes that improve dialysis efficiency. However, it is not ready for immediate use, which is why it may take weeks to mature before it can be used.

5. Which condition is characterized by a harsh, barking cough in children?

• A. Asthma
• B. Bronchiolitis
• C. Croup
• D. Pneumonia

Correct answer: C

Rationale: Croup is the correct answer. It is characterized by a harsh, barking cough due to inflammation of the upper airways, specifically the larynx and trachea. Asthma (Choice A) often presents with wheezing and shortness of breath, not a barking cough. Bronchiolitis (Choice B) typically causes wheezing and respiratory distress in infants. Pneumonia (Choice D) manifests with symptoms such as fever, productive cough, and chest pain, but not usually a barking cough.

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