Nursing Elites

1. A breastfeeding mother reports to the nurse that her newborn nurses every hour and never seems satisfied. Which advice should the nurse provide?

• A. Supplement breastfeeding with formula after each nursing session.
• B. Allow the newborn to nurse on each breast for at least 20 minutes.
• C. Reduce the number of nursing sessions to every 2-3 hours.
• D. Ensure the newborn has a proper latch and is effectively nursing.

Correct answer: D

Rationale: The nurse should ensure that the newborn has a proper latch and is effectively nursing. Sometimes, newborns nurse frequently for comfort even when they are effectively latched. It is essential to address the latch first before considering other interventions. Supplementing with formula (Choice A) may decrease the mother's milk supply. Allowing the newborn to nurse for a set time (Choice B) may not address the underlying latch issue. Reducing nursing sessions (Choice C) may lead to decreased milk production and does not address the latch problem.

2. You are assessing a 26-year-old woman who is 38 weeks pregnant and is in labor. She tells you that she was pregnant once before but had a miscarriage at 19 weeks. You should document her obstetric history as:

• A. gravida 2, para 1.
• B. gravida 2, para 0.
• C. gravida 1, para 1.
• D. gravida 0, para 2.

Correct answer: B

Rationale: In obstetrics, gravida indicates the number of pregnancies, including the current one. Para indicates the number of pregnancies carried to viability (20 weeks or more). Since the patient has been pregnant twice but only carried one pregnancy past 20 weeks, her obstetric history should be documented as gravida 2, para 0. The miscarriage at 19 weeks does not contribute to the para count. Choice A (gravida 2, para 1) would indicate that she has had two pregnancies with one resulting in a live birth, which is incorrect. Choice C (gravida 1, para 1) would indicate that she has had one pregnancy with one live birth, which does not reflect her obstetric history. Choice D (gravida 0, para 2) would indicate that she has never been pregnant past 20 weeks, which is also inaccurate.

3. How should the nurse prepare the sibling of a near-drowning accident victim who wants to see his brother in the pediatric intensive care unit, considering the child was present during the accident?

• A. Have the parents explain to the child why the sibling is so sick and inform the child that this could be the last time he sees his brother.
• B. Reassure the sibling not to cry in the child's room to avoid upsetting the ill child.
• C. If death is imminent, avoid informing the child about it and minimize involvement in care to protect the child from further trauma.
• D. Cover tubes and wires with a sheet, wash off any existing blood, and prepare him for what he will see.

Correct answer: D

Rationale: When preparing a sibling to see their brother in the pediatric intensive care unit after a near-drowning accident, it is essential to cover tubes and wires with a sheet, wash off any existing blood, and explain what the sibling will see. This approach helps the sibling understand the situation better and prepares them emotionally for the encounter, reducing potential distress and trauma. By providing information and visual preparation, the sibling can have a more controlled and less overwhelming experience when visiting their brother in the intensive care unit. Choice A is incorrect as informing the child that this could be the last time he sees his sibling may cause unnecessary distress and anxiety. Choice B is incorrect as it dismisses the sibling's emotional response, which is essential to address in a supportive manner. Choice C is incorrect as honesty and appropriate information sharing are crucial, even in difficult situations, to help the child cope effectively with the circumstances.

4. In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following?

• A. Anterior pituitary gland hypofunction
• B. Posterior pituitary gland hyperfunction
• C. Parathyroid gland hyperfunction
• D. Thyroid gland hyperfunction

Correct answer: A

Rationale: Short stature in growing children can result from anterior pituitary gland hypofunction, which leads to growth hormone deficiency. The anterior pituitary gland plays a crucial role in stimulating the release of growth hormone, and when it is underactive (hypofunction), insufficient growth hormone is produced, resulting in short stature and slow growth rates.

5. 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.

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