Nursing Elites

1. What should the nurse explain about ringworm?

• A. It is not contagious
• B. It is a sign of uncleanliness
• C. It is expected to resolve spontaneously
• D. It is spread by both direct and indirect contact

Correct answer: D

Rationale: Ringworm is a fungal infection that spreads through direct and indirect contact. Good hygiene practices can help prevent its spread.

2. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care would include what?

• A. Monitor closely for signs of infection.
• B. Place the child with the operative side of the head up.
• C. Avoid pumping the shunt reservoir to maintain patency.
• D. Avoid maintaining a Trendelenburg position to decrease pressure on the shunt.

Correct answer: A

Rationale: Postoperative nursing care for an infant with hydrocephalus who underwent ventriculoperitoneal shunt placement includes monitoring closely for signs of infection, as infection is the greatest hazard in the postoperative period. Signs of cerebrospinal fluid infection to watch for include elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity. The child should be placed with the operative side of the head up to reduce pressure on the valve. The shunt reservoir should not be pumped to maintain patency, as this can disrupt its function. Maintaining a Trendelenburg position to decrease pressure on the shunt is contraindicated as it can lead to increased intracranial pressure and compromise the shunt's effectiveness.

3. A child with acetylsalicylic acid (aspirin) poisoning is being admitted to the emergency department. What early clinical manifestation does the nurse expect to assess on this child?

• A. Hematemesis
• B. Hematochezia
• C. Hyperglycemia
• D. Hyperventilation

Correct answer: D

Rationale: Early signs of aspirin poisoning include hyperventilation due to the stimulation of the respiratory center and the resultant respiratory alkalosis. Hematemesis, hematochezia, and hyperglycemia can occur later in the poisoning process or may not be directly related to aspirin toxicity.

4. The nurse is caring for a child with suspected ingestion of some type of poison. What action should the nurse take next after initiating cardiopulmonary resuscitation (CPR)?

• A. Empty the mouth of pills, plants, or other material.
• B. Question the victim and witness.
• C. Place the child in a side-lying position.
• D. Call poison control.

Correct answer: D

Rationale: After ensuring the child's immediate survival needs are met with CPR, contacting poison control is critical to receive specific guidance on how to proceed with treatment. Other actions may be necessary depending on the situation but should follow contacting poison control.

5. Which statement best describes colic?

• A. Periods of abdominal pain resulting in weight loss
• B. Usually the result of poor or inadequate mothering
• C. Periods of abdominal pain and crying occurring in infants older than age 6 months
• D. A paroxysmal abdominal pain or cramping manifested by episodes of loud crying

Correct answer: D

Rationale: Colic is characterized by episodes of loud, inconsolable crying, often due to abdominal discomfort, and typically occurs in infants younger than 6 months. It is not related to poor mothering, nor does it necessarily result in weight loss.

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