Nursing Elites

1. Which finding suggests fluid volume deficit in an infant presenting with vomiting and diarrhea for 2 days?

• A. Increased blood pressure
• B. A sunken fontanel
• C. Decreased pulse rate
• D. Low urine specific gravity

Correct answer: B

Rationale: A sunken fontanel is a classic sign of dehydration in infants, indicating a fluid volume deficit. In dehydration, the fontanel sinks due to decreased fluid volume in the body. Increased blood pressure (Choice A) is not typically associated with dehydration in infants. Decreased pulse rate (Choice C) is not a common finding in fluid volume deficit, as the body tries to increase the heart rate to compensate for decreased volume. Low urine specific gravity (Choice D) may be seen in dehydration, but it is not as specific or as easily observable as a sunken fontanel.

2. An infant weighed 8 lb at birth and was 18 inches in length. What weight and length should the infant be at 5 months of age?

• A. 12 lb, 20 inches
• B. 14 lb, 21.5 inches
• C. 16 lb, 23 inches
• D. 18 lb, 24.5 inches

Correct answer: C

Rationale: By 5 months, an infant's weight should typically double from birth, and length should increase by approximately 50%.

3. Where would nonpathologic cyanosis normally be present in the newborn shortly after birth?

• A. Feet and hands
• B. Bridge of nose
• C. Circumoral area
• D. Mucous membranes

Correct answer: A

Rationale: Nonpathologic cyanosis in newborns shortly after birth is typically present in the feet and hands, known as acrocyanosis. This is a normal finding due to the immature peripheral circulation in newborns. Cyanosis of the bridge of the nose, circumoral area, and mucous membranes indicates generalized cyanosis, which suggests a potential underlying distress or major abnormality. Therefore, choice A is correct as it describes the expected location for nonpathologic cyanosis in newborns, while choices B, C, and D represent areas associated with abnormal cyanosis.

4. What is the most appropriate nursing action when intermittently gavage feeding a preterm infant?

• A. Allow formula to flow by gravity
• B. Avoid allowing the infant to suck on the tube
• C. Insert the tube through the nares instead of the mouth
• D. Apply gentle pressure to the syringe to deliver the formula

Correct answer: A

Rationale: The correct action when intermittently gavage feeding a preterm infant is to allow the formula to flow by gravity. This method helps prevent overfeeding and aspiration, which can occur if the formula is delivered too quickly under pressure. Choice B is incorrect as sucking on the tube can cause complications. Choice C is incorrect as the tube is typically inserted through the mouth. Choice D is incorrect as steady pressure can lead to rapid delivery of the formula, increasing the risk of complications.

5. What is the number one leading cause of death in children over 1 year of age?

• A. Congenital anomalies
• B. Homicide
• C. Suicide
• D. Accidents

Correct answer: D

Rationale: Accidents, such as motor vehicle accidents, drowning, and falls, are the primary cause of death in children over 1 year of age. While congenital anomalies can be a significant cause of mortality in infants, they are less common in older children. Homicide and suicide are serious issues but are not as prevalent as accidents in causing death among children over 1 year of age.

Similar Questions