Nursing Elites

1. A home care nurse is visiting a family for the first time. The 4-week-old infant had surgery for exstrophy of the bladder and creation of an ileal conduit soon after birth. When the nurse arrives, the mother appears tired, and the baby is crying. After an introduction, which is the most appropriate statement by the nurse?

• A. “Tell me about your daily routine.”
• B. “You look tired. Is everything alright?”
• C. “When was the last time the baby had a bottle?”
• D. “Oh, it looks like you two are having a bad day.”

Correct answer: A

Rationale: Asking about the daily routine is the most appropriate statement by the nurse in this scenario. It allows the nurse to gather important information about the family's schedule, feeding patterns, and overall care routine for the infant. This open-ended question helps the nurse assess the family's situation comprehensively and identify any areas where support may be needed. Choices B, C, and D are less appropriate as they do not focus on gathering relevant information about the family's routine and needs but rather make assumptions or ask about specific isolated events.

2. What should the nurse include in the preoperative teaching for a 4-year-old child scheduled for a tonsillectomy?

• A. Explaining the procedure in detail
• B. Encouraging deep breathing exercises
• C. Discussing the importance of hydration
• D. Using play therapy to prepare the child

Correct answer: B

Rationale: Encouraging deep breathing exercises is crucial preoperative teaching for a child scheduled for a tonsillectomy as it helps improve lung function and can prevent postoperative complications like pneumonia. Explaining the procedure in detail may heighten the child's anxiety, making it less ideal. While discussing hydration is important, it may not be the top priority for preoperative teaching for this specific procedure. Play therapy can reduce fear and anxiety, but encouraging deep breathing exercises directly contributes to better postoperative outcomes by enhancing respiratory function.

3. The mother of a 5-year-old boy with a myelomeningocele, who has developed a sensitivity to latex, is being taught by the nurse. Which response from his mother indicates a need for further teaching?

• A. He needs to wear a medical alert identification.
• B. I will need to inform his caregivers about his latex sensitivity.
• C. A product's label always indicates whether it is latex-free.
• D. He must avoid any contact with latex.

Correct answer: C

Rationale: Choice C, 'A product's label always indicates whether it is latex-free,' indicates a need for further teaching. Not all products are clearly labeled as latex-free; therefore, it is essential to verify with manufacturers and healthcare providers. Choices A, B, and D demonstrate appropriate understanding of managing latex sensitivity in the child. Wearing a medical alert identification (Choice A), informing caregivers (Choice B), and avoiding all contact with latex (Choice D) are all important aspects of managing a child's latex sensitivity.

4. When developing the plan of care for a child with burns requiring fluid replacement therapy, what information would the nurse expect to include?

• A. Administration of colloid initially followed by a crystalloid
• B. Determination of fluid replacement based on the type of burn
• C. Administration of most of the volume during the first 8 hours
• D. Monitoring of hourly urine output to achieve less than 1 mL/kg/hr

Correct answer: C

Rationale: The correct answer is C. In fluid replacement therapy for burns, the majority of the volume should be administered within the first 8 hours to prevent shock and maintain perfusion. Choice A is incorrect because crystalloids are typically administered first in fluid resuscitation for burns. Choice B is incorrect as fluid replacement in burn patients is primarily determined by the extent of the burn injury rather than the type of burn. Choice D is incorrect as the goal for hourly urine output in burn patients is generally higher, aiming for 1-2 mL/kg/hr in children to ensure adequate renal perfusion and prevent dehydration.

5. A child has undergone surgery using steel bar placement to correct pectus excavatum. What position would the nurse instruct the parents to avoid?

• A. Semi-Fowler
• B. Supine
• C. High Fowler
• D. Side-lying

Correct answer: D

Rationale: The correct answer is D: Side-lying. After surgery using steel bar placement to correct pectus excavatum, the nurse should instruct the parents to avoid placing the child in a side-lying position. This position should be avoided to prevent displacement of the steel bar. Choices A, B, and C are incorrect. Semi-Fowler, Supine, and High Fowler positions are generally safe and commonly used in postoperative care, but in this specific case, side-lying should be avoided to ensure the effectiveness of the surgical correction.

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