Nursing Elites

1. A 12-month-old child presents to the clinic for a well visit after missing several appointments. The child began her immunization schedule but has missed several follow-up appointments and doses of immunizations. What is the most appropriate nursing intervention?

• A. Administer initial immunizations from the beginning of the schedule.
• B. The child cannot receive missed immunizations if the schedule is not followed and will not be vaccinated.
• C. The child should only receive the missed doses of immunizations based on the catch-up schedule.
• D. The child should receive double-strength immunizations at this well visit.

Correct answer: C

Rationale: Children who began primary immunization at the recommended age but fail to receive all the doses do not need to begin the series again but should receive only the missed doses. The child may receive missed vaccinations on a catch-up schedule per CDC guidelines.

2. The nurse is preparing to care for a newborn with an omphalocele. The nurse should understand that care of the infant should include what intervention?

• A. Initiating breast or bottle-feedings to stabilize the blood glucose level
• B. Maintaining pain management with an intravenous opioid
• C. Covering the intact bowel with a nonadherent dressing to prevent injury
• D. Performing immediate surgery

Correct answer: C

Rationale: The priority intervention for an infant with an omphalocele is to cover the intact bowel with a nonadherent dressing to protect the exposed organs and prevent infection. This intervention is crucial to prevent injury and maintain the infant's safety. Initiating feedings or maintaining pain management are not the immediate priorities in the care of an infant with an omphalocele. Performing immediate surgery may be required in the future, but initially, covering the bowel is the first critical step in management.

3. The nurse is talking to a group of parents of school-age children at an after-school program about childhood health problems. Which statement should the nurse include in the teaching?

• A. Childhood obesity is the most common nutritional problem among children
• B. Immunization rates are the same among children of different races and ethnicity
• C. Dental caries is not a problem commonly seen in children since the introduction of fluoridated water
• D. Mental health problems are typically not seen in school-age children but may be diagnosed in adolescents

Correct answer: A

Rationale: Childhood obesity is the most common nutritional problem in children, with significant implications for long-term health, including the risk of developing chronic diseases.

4. Two children are working on a puzzle together in the hospital playroom. Which type of play describes this activity?

• A. Solitary play
• B. Associative play
• C. Parallel play
• D. Cooperative play

Correct answer: D

Rationale: The correct answer is D, cooperative play. In cooperative play, children work together toward a common goal, such as completing a puzzle. Solitary play (A) is when a child plays alone, associative play (B) involves children playing together but without a common goal, and parallel play (C) is when children play alongside each other without direct interaction.

5. What is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

• A. The dorsal gluteal muscle
• B. The vastus lateralis muscle
• C. The ventral gluteal muscle
• D. The biceps muscle

Correct answer: B

Rationale: The correct site to administer an intramuscular (IM) vaccine to a newborn is the vastus lateralis muscle. For newborns, the vastus lateralis is preferred over the dorsogluteal site because the dorsogluteal site has been associated with low antibody seroconversion rates, indicating a reduced immune response. The vastus lateralis is also recommended for IM injections in newborns, while the deltoid muscle is preferred for older infants and children. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections. Therefore, choice B is the correct answer.

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