Nursing Elites

1. A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?

• A. 5% dextrose infusion
• B. Normal saline infusion
• C. NPH insulin infusion
• D. Potassium infusion

Correct answer: B

Rationale: In the management of diabetic ketoacidosis (DKA), the initial intravenous (IV) fluid of choice is normal saline infusion. Normal saline helps to correct dehydration and electrolyte imbalances commonly seen in DKA patients. It does not contain glucose to prevent worsening hyperglycemia or ketoacidosis. NPH insulin infusion is not the initial treatment for DKA; it is typically used after fluid resuscitation. Potassium infusion may be required in DKA to address electrolyte imbalances, but normal saline is the priority for fluid resuscitation.

2. During your assessment of a woman in labor, you see the baby's arm protruding from the vagina. The mother tells you that she needs to push. You should:

• A. gently push the protruding arm back into the vagina.
• B. encourage the mother to push and give her high-flow oxygen.
• C. insert your gloved fingers into the vagina and try to turn the baby.
• D. cover the arm with a sterile towel and transport immediately.

Correct answer: D

Rationale: When encountering a protruding limb during delivery, it is crucial to recognize this as an emergency situation. The correct action is to cover the limb with a sterile towel to prevent injury and transport the mother immediately to a medical facility. Attempting to push the limb back into the vagina or trying to manipulate the baby's position can be harmful and delay necessary medical intervention. Encouraging the mother to push and providing high-flow oxygen is not appropriate in this scenario as immediate transport is essential to ensure the safety of both the mother and the baby.

3. Use this scenario to answer questions 70 to 72. Madam KK brought her two-month-old sick child to your facility. She complains that the child is having a fever, fast breathing, and is not eating anything. Using the IMNCI, what will be the steps to manage this child?

• A. i. Provide practical treatment instructions
• B. ii. Triage based on the severity of illness
• C. iii. Perform a head-to-toe assessment
• D. iv. Identify specific treatments

Correct answer: D

Rationale: To manage the sick child using IMNCI, the correct steps are as follows: Triage based on the severity of illness, Perform a head-to-toe assessment, Identify specific treatments, Provide practical treatment instructions, and Assess feeding while providing counseling. The correct answer, 'D,' focuses on identifying specific treatments, which is crucial in addressing the child's condition effectively. Choice A ('Provide practical treatment instructions') is not the initial step and should come after identifying specific treatments. Choice B ('Triage based on the severity of illness') and Choice C ('Perform a head-to-toe assessment') are essential steps but should follow the identification of specific treatments in the IMNCI approach.

4. 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.

5. The healthcare provider is preparing to administer Rh immune globulin (RhoGAM) to a postpartum client. This medication is indicated for:

• A. Rh-negative individuals with Rh-positive infants
• B. Rh-positive individuals with Rh-negative infants
• C. All individuals regardless of Rh status
• D. Individuals with a history of Rh incompatibility

Correct answer: A

Rationale: Rh immune globulin (RhoGAM) is administered to Rh-negative individuals who have given birth to Rh-positive infants to prevent Rh sensitization. When an Rh-negative individual gives birth to an Rh-positive infant, there is a risk of the mother developing antibodies against the Rh-positive blood cells, which can lead to hemolytic disease of the newborn in subsequent pregnancies. Rh immune globulin is given to prevent this sensitization in Rh-negative individuals who deliver Rh-positive infants.

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