Nursing Elites

1. A child with a diagnosis of gastroesophageal reflux disease (GERD) is being discharged. What dietary instructions should the nurse provide?

• A. Avoid spicy foods
• B. Avoid gluten
• C. Avoid high-fat foods
• D. Avoid dairy products

Correct answer: C

Rationale: The correct dietary instruction for a child with GERD is to avoid high-fat foods. High-fat foods can relax the lower esophageal sphincter, leading to increased reflux. While avoiding gluten may be necessary for individuals with gluten sensitivity or celiac disease, it is not a standard recommendation for GERD. Avoiding spicy foods and dairy products may help some individuals with GERD, but the most crucial dietary advice is to avoid high-fat foods.

2. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. Which of the following statements regarding crowning is true?

• A. Crowning represents the end of the second stage of labor.
• B. Crowning always occurs immediately after the amniotic sac has ruptured.
• C. It is safe to transport the patient during crowning if the hospital is close.
• D. Gentle pressure should be applied to the baby's head during crowning.

Correct answer: D

Rationale: During crowning, it is essential to apply gentle pressure to the baby's head to prevent rapid delivery, which can lead to potential injuries to both the mother and the baby. Choice A is incorrect because crowning signifies the beginning, not the end, of the second stage of labor. Choice B is incorrect as crowning can occur before or after the amniotic sac ruptures. Choice C is incorrect as transporting the patient during crowning, even if the hospital is close, can be unsafe due to the risk of rapid delivery and complications.

3. A nurse is assessing a 2-year-old child with suspected Down syndrome. What characteristic physical feature is the nurse likely to observe?

• A. Epicanthal folds
• B. Webbed neck
• C. Enlarged head
• D. Polydactyly

Correct answer: A

Rationale: Epicanthal folds are a distinctive physical feature commonly observed in individuals with Down syndrome. These are horizontal skin folds that cover the inner corners of the eyes. Webbed neck (choice B) is not typically associated with Down syndrome but can be seen in conditions like Turner syndrome. Enlarged head (choice C) is not a characteristic feature of Down syndrome; however, individuals with hydrocephalus may present with this finding. Polydactyly (choice D) is the presence of extra fingers or toes, which is not a typical feature of Down syndrome.

4. A 2-week-old infant is admitted with a tentative diagnosis of a ventricular septal defect. The parents report that their baby has had difficulty feeding since coming home after birth. What should the nurse consider before responding?

• A. Feeding problems are common in neonates.
• B. Inadequate sucking is not significant in the absence of cyanosis.
• C. Ineffective sucking and swallowing may be early indications of a heart defect.
• D. Many neonates retain mucus, which may interfere with feeding for several weeks.

Correct answer: C

Rationale: In this scenario, the nurse should consider that ineffective sucking and swallowing in a 2-week-old infant could be early signs of a heart defect such as a ventricular septal defect. This is crucial information as it can guide further assessment and management. Choice A is incorrect because while feeding problems can be common in neonates, in this case, the specific context of a suspected heart defect should be prioritized. Choice B is incorrect as inadequate sucking can indeed be significant, especially when considering potential underlying heart issues, regardless of the presence of cyanosis. Choice D is incorrect as while mucus retention can affect feeding, in this case, the focus should be on the possibility of a heart defect rather than a temporary issue like mucus interference.

5. What is the priority nursing responsibility when a 3-year-old child in a crib is experiencing a tonic-clonic seizure with a clamped jaw?

• A. Apply restraints.
• B. Administer oxygen.
• C. Protect the child from self-injury.
• D. Insert a plastic airway in the child’s mouth.

Correct answer: C

Rationale: During a tonic-clonic seizure, the priority nursing responsibility is to protect the child from self-injury. Applying restraints (Choice A) can cause harm by restricting movement during the seizure. While administering oxygen (Choice B) may be necessary, it is not the immediate priority during an active seizure. Inserting a plastic airway (Choice D) is contraindicated as it can lead to injury and is not recommended during a seizure. Protecting the child from self-injury (Choice C) is crucial to prevent harm from uncontrolled movements and potential falls, ensuring the safety of the child.

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