Nursing Elites

1. A 4-year-old boy with a tracheostomy tube is experiencing respiratory distress. He has intercostal retractions, a heart rate of 80 beats/min, and an oxygen saturation of 85%. During his attempts to breathe, a gurgling sound is heard in the tracheostomy tube. You should:

• A. Ventilate through the tracheostomy tube.
• B. Place an oxygen mask over the tracheostomy tube.
• C. Remove the tracheostomy tube and clean it.
• D. Carefully suction the tracheostomy tube.

Correct answer: D

Rationale: In this scenario, the 4-year-old boy with a tracheostomy tube is showing signs of respiratory distress, including intercostal retractions, a low heart rate, and decreased oxygen saturation. The gurgling sound indicates a possible airway obstruction. Correctly, the immediate action should be to carefully suction the tracheostomy tube. Suctioning can help clear any secretions or obstructions, thus improving the child's ability to breathe effectively. Ventilating through the tube, placing an oxygen mask over it, or removing and cleaning the tube would not address the potential obstruction and could worsen the respiratory distress.

2. The healthcare provider is teaching a new mother how to care for her newborn's umbilical cord. Which instruction should be included?

• A. Keep the cord dry and exposed to air
• B. Clean the cord with alcohol at every diaper change
• C. Cover the cord with a sterile dressing
• D. Submerge the cord in water during baths

Correct answer: A

Rationale: Keeping the umbilical cord dry and exposed to air is the correct instruction because it promotes faster healing. Moisture can delay the healing process and increase the risk of infection. Cleaning the cord with alcohol at every diaper change or covering it with a sterile dressing can actually impede the healing process by preventing airflow. Submerging the cord in water during baths is not recommended as it can introduce moisture and increase the risk of infection.

3. You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should:

• A. reassess the newborn every 5 minutes and transport after the placenta delivers.
• B. keep the newborn warm, give oxygen to the mother if needed, and transport.
• C. massage the lower part of the mother's uterus until the placenta delivers.
• D. give the newborn high-flow oxygen via a non-rebreathing mask and transport.

Correct answer: B

Rationale: In this scenario, the appropriate action is to keep the newborn warm, ensure the mother receives oxygen if needed, and prepare for transport. The newborn is showing signs of central cyanosis (hands and feet being cyanotic), which can be due to various reasons, including inadequate oxygenation. Therefore, ensuring warmth and possible oxygen to the mother are important. Additionally, monitoring both the mother and baby during transport is crucial for their well-being.

4. Which of the following are not infectious causes of diarrhea?

• A. Allergy
• B. Bacteria
• C. Parasite
• D. Virus

Correct answer: A

Rationale: Diarrhea can be caused by various infectious agents such as bacteria, parasites, and viruses. Allergy, on the other hand, is a non-infectious cause of diarrhea. When an individual with a food allergy consumes the specific food they are allergic to, it can trigger diarrhea as a part of the allergic reaction.

5. Which of the following statements regarding the length-based resuscitation tape measure is correct?

• A. The resuscitation tape estimates a child's weight based on his or her height.
• B. It is a reliable tool in children who are less than 5 years of age.
• C. The red end of the tape measure is placed at the top of the child's head.
• D. The tape measure can be used in children who weigh up to 75 pounds.

Correct answer: D

Rationale: The length-based resuscitation tape measure is designed to estimate a child's weight based on their length and can be used for children weighing up to 75 pounds. It is a reliable tool for pediatric weight estimation in emergency situations.

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