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. Fred, a 12-year-old boy, is diagnosed with pneumococcal pneumonia. Which of the following symptoms would Nurse Nica expect to assess?

• A. Mild cough
• B. Slight fever
• C. Chest pain
• D. Bulging fontanel

Correct answer: C

Rationale: Chest pain is a common symptom associated with pneumococcal pneumonia. It can occur due to inflammation of the pleura or irritation of the lung tissue, leading to sharp or stabbing pain that worsens with breathing or coughing. While cough and fever are also common with pneumonia, chest pain is particularly significant in this case.

3. When a father asks why his child with tetralogy of Fallot seems to favor a squatting position, the nurse would explain that squatting:

• A. Increases peripheral vascular resistance
• B. Decreases arterial blood flow away from the heart
• C. It's a common resting position when a child is tachycardic
• D. Increases the workload of the heart

Correct answer: A

Rationale: Squatting increases systemic vascular resistance, which leads to a reduction in the right-to-left shunting of blood in children with tetralogy of Fallot. This helps improve oxygenation by balancing the pulmonary and systemic blood flow. The squatting position decreases the pressure in the right ventricle and reduces the magnitude of the right-to-left shunt by increasing afterload, thereby improving oxygenation. Choices B, C, and D are incorrect because squatting does not decrease arterial blood flow away from the heart, is not related to being tachycardic, and does not increase the workload of the heart.

4. Which of the following are clinical types of diarrhoea EXCEPT?

• A. Acute watery
• B. Bloody diarrhoea
• C. Persistent diarrhoea
• D. Secretory diarrhoea

Correct answer: D

Rationale: Secretory diarrhoea is not a clinical type but a distinct mechanism of diarrhoea characterized by increased electrolyte secretion. Acute watery, bloody, and persistent diarrhoea are recognized clinical types associated with different underlying causes and pathophysiologies. Acute watery diarrhoea is common in infectious gastroenteritis, bloody diarrhoea can be caused by inflammatory conditions or infections, and persistent diarrhoea typically lasts for more than 14 days due to various reasons like infections, malabsorption, or inflammatory bowel diseases.

5. The healthcare provider is assessing a postpartum client who is 1 day post-delivery. Which finding would require immediate intervention?

• A. Lochia rubra with a few small clots
• B. Fundus firm and midline
• C. Temperature of 100.4°F (38°C)
• D. Saturated perineal pad in 15 minutes

Correct answer: D

Rationale: A saturated perineal pad in 15 minutes indicates excessive bleeding, known as postpartum hemorrhage, which is a critical condition requiring immediate intervention to prevent further complications like hypovolemic shock. Monitoring and managing postpartum bleeding are crucial in the early postpartum period to ensure the client's safety and well-being. The other options are normal postpartum findings: lochia rubra with a few small clots is expected in the early postpartum period, a firm and midline fundus indicates proper uterine contraction, and a temperature of 100.4°F (38°C) is within the normal range for the postpartum period.

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