Nursing Elites

1. When planning care for a newborn with esophageal atresia and tracheoesophageal fistula, which is the priority nursing diagnosis?

• A. Ineffective Tissue Perfusion
• B. Ineffective Infant Feeding Pattern
• C. Acute Pain
• D. Risk for Aspiration

Correct answer: D

Rationale: The priority nursing diagnosis for a newborn with esophageal atresia and tracheoesophageal fistula is 'Risk for Aspiration' because of the potential respiratory complications associated with these conditions. The newborn is at a higher risk of aspirating oral or gastric contents due to the abnormal connections between the esophagus and trachea, posing a serious threat to the airway and lungs. Addressing this risk is crucial to prevent respiratory distress and maintain the airway's patency, making it the priority nursing diagnosis in this scenario. 'Ineffective Tissue Perfusion' is not the priority as respiratory compromise takes precedence over perfusion concerns. 'Ineffective Infant Feeding Pattern' may be relevant but addressing the risk of aspiration is more critical. 'Acute Pain' is not the priority compared to the life-threatening risk of aspiration.

2. A patient is prescribed Lisinopril as part of the treatment plan for heart failure. Which finding indicates the patient is experiencing the therapeutic effect of this drug?

• A. Weight gain of 5 pounds in 1 week
• B. Potassium level of 3.5mEq/L
• C. Crackles in the lungs are no longer heard
• D. Jugular vein distention

Correct answer: C

Rationale: The correct answer is C. Lisinopril, an ACE inhibitor, promotes venous dilation, which helps reduce pulmonary congestion and peripheral edema. The absence of previously heard crackles in the lungs indicates effectiveness in reducing pulmonary congestion. Edema and jugular vein distention are signs of heart failure and would not indicate the therapeutic effect of Lisinopril. A potassium level of 3.5mEq/L is within the normal range and not directly related to the therapeutic effect of Lisinopril.

3. A 9-month-old infant who is not sitting independently has been diagnosed with ataxic cerebral palsy (CP). Which clinical manifestations would the nurse expect to see in the baby?

• A. Hypotonia and muscle instability
• B. Hypertonia and persistence of primitive reflexes
• C. Tremors and exaggerated posturing
• D. Hemiplegia and hypertonia

Correct answer: A

Rationale: In ataxic cerebral palsy, the characteristic features include hypotonia (low muscle tone) and muscle instability. These manifestations contribute to the infant's difficulty in achieving independent sitting. Hypertonia (increased muscle tone) and persistence of primitive reflexes, as mentioned in option B, are more commonly associated with other types of cerebral palsy like spastic CP. Tremors and exaggerated posturing (option C) are not typical features of ataxic CP. Hemiplegia (paralysis of one side of the body) and hypertonia (increased muscle tone) mentioned in option D are more commonly seen in other types of cerebral palsy, such as spastic CP.

4. A neonate with a meningomyelocele is scheduled for surgery in the morning. Which nursing action is appropriate for this neonate?

• A. Applying a diaper to prevent contamination of the sac
• B. Positioning the newborn in a side-lying position
• C. Encouraging the mother to hold the newborn because she will not be able to pick him up after surgery
• D. Positioning the newborn in a prone position

Correct answer: D

Rationale: Positioning the newborn in a prone position is appropriate for a neonate with a meningomyelocele before surgery. Placing the newborn in this position helps prevent pressure on the sac, reducing the risk of damaging it and promoting optimal surgical outcomes. Applying a diaper (choice A) may not be recommended as it can increase pressure on the sac. Positioning the newborn in a side-lying position (choice B) or encouraging the mother to hold the newborn (choice C) are not ideal actions before surgery as they do not address the specific needs of a neonate with a meningomyelocele.

5. The renin-angiotensin-aldosterone system plays an important role in maintaining blood pressure. Which compound in this system is most powerful at raising blood pressure?

• A. Angiotensin I
• B. Angiotensin II
• C. Angiotensin III
• D. Renin

Correct answer: B

Rationale: Angiotensin II is the most potent compound in the renin-angiotensin-aldosterone system for raising blood pressure. It acts as a powerful vasoconstrictor, leading to increased systemic vascular resistance. Angiotensin II is formed from angiotensin I through the action of the angiotensin-converting enzyme. While renin initiates the cascade by converting angiotensinogen to angiotensin I, it is angiotensin II that exerts the strongest pressor effect.

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