Nursing Elites

1. A breastfeeding mother reports breast engorgement. The nurse advises her to:

• A. Increase the frequency of feedings
• B. Apply ice packs to the breasts
• C. Avoid breastfeeding until the pain subsides
• D. Use a breast pump to empty the breasts completely

Correct answer: A

Rationale: Breast engorgement occurs when the breasts become overfilled with milk. By increasing the frequency of feedings, the mother can ensure that her breasts are emptied regularly, helping to relieve the discomfort associated with engorgement. This advice promotes effective milk removal and prevents further accumulation, which can worsen the condition. Applying ice packs may provide temporary relief, but it does not address the underlying issue of milk accumulation. Avoiding breastfeeding can lead to further engorgement and potential complications. Using a breast pump to empty the breasts completely may be necessary in some cases, but increasing the frequency of feedings is the initial and most appropriate intervention to manage breast engorgement.

2. The provider is educating the parents of a newborn about circumcision care. Which of the following instructions should be included?

• A. Cleanse the penis with each diaper change using alcohol wipes.
• B. Avoid using petroleum jelly on the circumcision site.
• C. Report any yellowish exudate around the head of the penis.
• D. Use warm water to clean the penis gently during diaper changes.

Correct answer: D

Rationale: The correct instruction for circumcision care is to use warm water to gently clean the penis during diaper changes. Alcohol wipes should be avoided as they can cause irritation. Yellowish exudate around the head of the penis is a normal part of the healing process and does not require reporting unless accompanied by other concerning symptoms. Avoiding petroleum jelly on the circumcision site is important to prevent trapping moisture and bacteria, which can lead to infection.

3. Madam Esinam, a 45-year-old trader at the Kotokuraba community market, has brought her 8-year-old daughter Bubunyo to the clinic where you are working. According to her, Bubunyo eats very well but looks like her 5-year-old brother in terms of stature. What investigation would you request to give a definitive diagnosis of Bubunyo's condition?

• A. Renal and Liver function test
• B. Pancreatic function test
• C. Sedimentation rate (ESR)
• D. Growth hormone assessment

Correct answer: D

Rationale: A growth hormone assessment is necessary to definitively diagnose growth hormone deficiency, which could be a possible cause of Bubunyo's growth delay despite adequate nutrition. This test will help determine if Bubunyo's growth issues are related to a lack of growth hormone production.

4. The nurse is planning the care of a hospitalized 4-year-old. The most appropriate technique the nurse can use to reduce the stress of hospitalization for this child is to:

• A. Encourage the child to discuss their feelings.
• B. Encourage peer visitation.
• C. Encourage the child to play with safe medical equipment.
• D. Read a story to the child.

Correct answer: C

Rationale: Encouraging the child to play with safe medical equipment is the most appropriate technique to reduce stress for a hospitalized child. This technique helps familiarize the child with medical equipment in a non-threatening way, empowering them to feel more in control of the environment. Options A, B, and D may be helpful but do not directly address the child's exposure and interaction with the hospital environment, making them less effective in reducing stress in this context.

5. The nurse is using the New Ballard Score to assess the gestational age of a newborn delivered 4 hours ago. The infant's gestational age is 33 weeks based on early ultrasound and last menstrual period. The nurse expects the infant to exhibit which of the following?

• A. Full sole creases, nails extending beyond the fingertips, scarf sign showing the elbow beyond the midline
• B. Testes located in the upper scrotum, rugae covering the scrotum, vernix covering the entire body
• C. Ear cartilage folded over, lanugo present over much of the body, slow recoil time
• D. 1 cm breast bud, peeling skin and veins not visible, rapid recoil of legs and arms to extension

Correct answer: C

Rationale: The correct answer is C. Ear cartilage folded over, lanugo present over much of the body, and slow recoil time are all characteristics of a preterm infant. A is incorrect because full sole creases, nails extending beyond the fingertips, and scarf sign showing the elbow beyond the midline are features of a term infant. B is incorrect as testes located in the upper scrotum, rugae covering the scrotum, and vernix covering the entire body are also indicative of a term infant. D is incorrect because a 1 cm breast bud, peeling skin and veins not visible, and rapid recoil of legs and arms to extension are characteristics seen in a more mature infant, not a preterm newborn.

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