Nursing Elites

1. A 30-year-old woman has severe lower abdominal pain and light vaginal bleeding. She tells you that her last menstrual period was 2 months ago. On the basis of these findings, you should suspect:

• A. a normal pregnancy.
• B. a ruptured ovarian cyst.
• C. an ectopic pregnancy.
• D. a spontaneous abortion.

Correct answer: C

Rationale: Severe lower abdominal pain, light vaginal bleeding, and a history of missed periods are concerning for an ectopic pregnancy. The absence of a normal menstrual period along with these symptoms raises suspicion for an ectopic pregnancy, which requires immediate medical attention due to the risk of rupture and life-threatening complications. A normal pregnancy would typically present with different symptoms such as a positive pregnancy test and typical signs of early pregnancy. A ruptured ovarian cyst may present with similar symptoms but typically lacks the history of missed periods. A spontaneous abortion usually involves heavier bleeding and tissue passage, which is not described in this scenario.

2. Before drying off the newborn after birth, which assessment finding should the healthcare professional document to ensure an accurate gestational rating on the Ballard gestational assessment tool?

• A. Amount and area of vernix coverage
• B. Creases on the sole
• C. Size of the areola
• D. Body surface temperature

Correct answer: A

Rationale: To ensure an accurate gestational rating on the Ballard gestational assessment tool, healthcare professionals should document the amount and area of vernix coverage before drying the newborn. Drying the baby after birth could disturb the vernix, potentially affecting the gestational age assessment. Assessing and documenting the vernix coverage beforehand enables a more precise evaluation using the Ballard gestational assessment tool. Choices B, C, and D are incorrect as they are not directly related to gestational rating on the Ballard assessment tool.

3. During the pediatric assessment process, which scenario would be the LEAST appropriate for the transition phase?

• A. A parent is available to help keep the child calm.
• B. The child is unstable and needs rapid transport.
• C. You determine that the child's condition is stable.
• D. Your transport time is greater than 30 minutes.

Correct answer: B

Rationale: During a pediatric assessment, the transition phase is a critical period where care is handed over from prehospital providers to the hospital team. If the child is unstable and requires rapid transport, it is not appropriate to delay for a transition phase. In such cases, immediate transport to a higher level of care is paramount to ensure the child's safety and well-being. Choice A is appropriate as having a parent present can help keep the child calm during the transition. Choice C is also appropriate as transitioning a stable child allows for a smoother handover. Choice D, while indicating a longer transport time, does not necessarily affect the need for a transition phase as long as the child's condition remains stable.

4. What percentage of total body surface area has been burned in a 5-year-old child who experienced partial-thickness burns to his head, anterior chest, and both upper extremities?

• A. 45%
• B. 63%
• C. 72%
• D. 54%

Correct answer: A

Rationale: According to the pediatric rule of nines, the head and neck represent 18%, the anterior chest and abdomen 18%, and each arm 9%. By adding these percentages (18% + 18% + 9% + 9% = 45%), we find that 45% of the total body surface area has been burned in this child.

5. When ventilating an apneic 3-year-old child with a bag-valve mask device, what is the MOST important action to take?

• A. Avoid hyperventilation and ensure adequate chest rise.
• B. Squeeze the bag with both hands and use a pediatric mask.
• C. Immediately insert an oropharyngeal airway.
• D. Provide one breath every 3 to 5 seconds.

Correct answer: A

Rationale: When ventilating an apneic child, the most important action is to avoid hyperventilation and ensure adequate chest rise. Hyperventilation can lead to decreased cardiac output and increased intracranial pressure. Adequate chest rise confirms effective ventilation and minimizes the risk of complications. Choice B is incorrect because using both hands to squeeze the bag may not ensure proper ventilation and can lead to complications. Choice C is incorrect as inserting an oropharyngeal airway is not the initial action in ventilating an apneic child with a bag-valve mask. Choice D is incorrect as providing ventilations every 3 to 5 seconds may not be appropriate for effective ventilation in a pediatric patient.

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