Nursing Elites

1. You are providing a home health care assessment for a very low-income mother with three young children under 5 who all appear to be at nutritional risk. Which program would you refer them to in an attempt to reduce the risk and safeguard the health of this family?

• A. Division of Maternal and Child Health
• B. Medicaid
• C. Supplemental Food Program for Women, Infants, and Children
• D. The State Children’s Health Insurance Program

Correct answer: C

Rationale: The correct answer is C, the Supplemental Food Program for Women, Infants, and Children (WIC). WIC provides nutritional assistance to low-income pregnant women, breastfeeding women, and children under 5. The Division of Maternal and Child Health (Choice A) focuses on promoting the health of mothers and children but does not provide direct nutritional assistance. Medicaid (Choice B) is a health insurance program for low-income individuals but does not specifically address nutritional needs. The State Children’s Health Insurance Program (Choice D) provides health insurance for children in low-income families but does not offer nutritional support like WIC does.

2. The nurse is caring for an infant who was born 24 hr ago to a mother who received no prenatal care. The infant is a poor feeder but sucks avidly on his hands. Clinical manifestations also include hyperactive reflexes, tremors, sneezing, and a high-pitched shrill cry. What does the nurse consider as a possible diagnosis for this infant?

• A. Seizure disorder
• B. Narcotic withdrawal
• C. Placental insufficiency
• D. Meconium aspiration syndrome

Correct answer: B

Rationale: In this case, the infant's symptoms are consistent with narcotic withdrawal. Infants exposed to drugs in utero may display withdrawal symptoms starting around 12 to 24 hours post-birth. The presentation often includes hyperactive reflexes, tremors, sneezing, high-pitched shrill cry, poor feeding, and sucking avidly on hands. Signs such as loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating are common. These symptoms are not indicative of a seizure disorder. Placental insufficiency typically leads to a small-for-gestational-age child, which is not mentioned in the scenario. Meconium aspiration syndrome primarily presents with respiratory distress, not the symptoms described in this case.

3. The parents of a child with sickle cell anemia ask why their child did not have a sickle cell crisis until he was approximately 6 months old. How should the nurse respond?

• A. Your child probably had a crisis, and you were unaware of the symptoms.
• B. Are you sure your child has sickle cell anemia and not sickle cell trait?
• C. Affected children can be asymptomatic in early infancy because of high levels of fetal hemoglobin that inhibit sickling.
• D. Have you asked your doctor about this yet?

Correct answer: C

Rationale: The correct answer is C. Fetal hemoglobin (HbF) is present in high levels during early infancy, inhibiting sickling unlike adult hemoglobin (HbS). As the levels of HbF decrease and HbS increases, the risk of sickling and crises becomes more pronounced, typically after 6 months of age. Choice A is incorrect because it assumes the crisis went unnoticed, which is not supported by medical knowledge. Choice B is incorrect as it questions the child's diagnosis rather than explaining the phenomenon of delayed crises. Choice D is incorrect as it does not provide the parents with the necessary information regarding their query.

4. What is a high-fiber food that the nurse should recommend for a child with chronic constipation?

• A. White rice
• B. Popcorn
• C. Fruit juice
• D. Ripe bananas

Correct answer: B

Rationale: Popcorn is a high-fiber food that can help manage chronic constipation in children. Other options like white rice and ripe bananas are low in fiber and less effective for treating constipation.

5. The nurse is teaching a parent with a 2-month-old infant who has been diagnosed with colic about ways to relieve colic. Which statement by the parent indicates the need for additional teaching?

• A. I should let my infant cry for at least 30 minutes before I respond.
• B. I will swaddle my infant tightly with a soft blanket.
• C. I should massage my infant's abdomen whenever possible.
• D. I will place my infant in an upright seat after feeding.

Correct answer: A

Rationale: Letting an infant cry for prolonged periods can exacerbate colic and increase the infant's distress. It is better to respond promptly to soothe the baby. Other methods like swaddling, gentle massage, and keeping the infant upright can help relieve colic symptoms.

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