Nursing Elites

1. A 6-month-old infant with Hirschsprung disease is scheduled for a temporary colostomy. What should postoperative teaching to the parents include?

• A. Dilating the stoma
• B. Assessing bowel function
• C. Limitation of physical activities
• D. Measures to prevent prolapse of the rectum

Correct answer: B

Rationale: Postoperative teaching should focus on assessing bowel function to ensure the colostomy is functioning properly. This includes monitoring stool output, color, consistency, and signs of infection or blockage. Choice A, dilating the stoma, is not recommended without healthcare provider guidance, as it can lead to complications. Choice C, limitation of physical activities, may not be as crucial immediately after colostomy creation. Choice D, measures to prevent prolapse of the rectum, is more relevant for conditions like rectal prolapse and not specifically for a colostomy.

2. Why is it difficult to assess a child’s dietary intake?

• A. No systematic assessment tool has been developed
• B. Biochemical analysis for assessing nutrition is expensive
• C. Families usually do not understand much about nutrition
• D. Recall of food consumption is frequently unreliable

Correct answer: D

Rationale: The correct answer is D. Recall of food intake, especially amounts eaten, is often unreliable. While systematic tools like the 24-hour recall and dietary history questionnaires exist, recall can still be challenging in accurately assessing a child's dietary intake. Choices A, B, and C are incorrect because systematic assessment tools do exist, biochemical analysis is not the primary method for dietary assessment, and families' understanding of nutrition may vary but is not the main reason for the difficulty in assessing a child's dietary intake.

3. What is the first step in managing a child with anaphylaxis?

• A. Administer antihistamines
• B. Establish IV access
• C. Administer epinephrine
• D. Monitor vital signs

Correct answer: C

Rationale: The correct answer is to administer epinephrine. Administering epinephrine is the crucial first step in managing anaphylaxis as it helps reverse the severe allergic reaction by constricting blood vessels and relaxing airway muscles, preventing a life-threatening situation. Antihistamines (Choice A) are not the first-line treatment for anaphylaxis and should not delay the administration of epinephrine. Establishing IV access (Choice B) may be necessary but is not the initial step in managing anaphylaxis. Monitoring vital signs (Choice D) is important but should not take precedence over administering epinephrine in the acute management of anaphylaxis.

4. The nurse is providing anticipatory guidance to the parent of a 9-month-old infant during a well-baby visit. Which topic would be most appropriate?

• A. Cautioning about putting the infant in a walker
• B. Advising how to create a toddler-safe home
• C. Instructing on safety procedures during baths
• D. Warning about leaving small objects on the floor

Correct answer: D

Rationale: The correct answer is D because at 9 months, infants become more mobile, increasing the risk of choking hazards from small objects left on the floor. Cautioning about putting the infant in a walker (Choice A) is not as crucial at this age as warning about choking hazards. While advising how to create a toddler-safe home (Choice B) is essential, the most critical concern at 9 months is small objects. Instructing on safety procedures during baths (Choice C) is important but does not address the immediate risk of choking hazards associated with small objects.

5. The nurse is caring for an adolescent who has just started dialysis. The child always seems angry, hostile, or depressed. The nurse should recognize that this is most likely related to what underlying cause?

• A. Physiologic manifestations of renal disease
• B. The fact that adolescents have few coping mechanisms
• C. Neurologic manifestations that occur with dialysis
• D. Resentment of the control and enforced dependence imposed by dialysis

Correct answer: D

Rationale: Adolescents may feel anger and depression due to the loss of independence and control over their lives, which is imposed by the need for regular dialysis treatments. This reaction is common as they struggle with the restrictions placed on their social and personal lives.

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