Nursing Elites

1. A mother brings her 3-month-old infant to the clinic, concerned about frequent vomiting after feeding. The practical nurse (PN) suspects gastroesophageal reflux (GER). Which recommendation should the PN provide to the mother?

• A. Feed the infant in a prone position.
• B. Provide larger, less frequent feedings.
• C. Keep the infant upright for 30 minutes after feeding.
• D. Offer only formula thickened with rice cereal.

Correct answer: C

Rationale: The correct recommendation for reducing symptoms of gastroesophageal reflux (GER) in infants is to keep the infant upright for 30 minutes after feeding. This position helps prevent the backflow of stomach contents, alleviating symptoms of reflux. Placing the infant in a prone position or providing larger, less frequent feedings may worsen symptoms by increasing the likelihood of regurgitation. Offering only formula thickened with rice cereal is not the first-line intervention for GER and should not be recommended initially.

2. A 9-year-old child with a history of type 1 diabetes is brought to the clinic for a check-up. The nurse notes that the child's hemoglobin A1c is 8.5%. What is the most appropriate action for the nurse to take?

• A. Increase the child’s insulin dose
• B. Review the child’s dietary habits and insulin administration technique
• C. Discuss the possibility of switching to oral hypoglycemics
• D. Schedule a follow-up appointment in three months

Correct answer: B

Rationale: A hemoglobin A1c of 8.5% indicates suboptimal diabetes control. The most appropriate action for the nurse in this scenario is to review the child’s dietary habits and insulin administration technique. This approach can help identify potential areas for improvement and optimize diabetes management, aiming to lower the hemoglobin A1c levels towards the target range. Increasing the child’s insulin dose (Choice A) without addressing dietary habits and administration technique may not lead to better control and can increase the risk of hypoglycemia. Switching to oral hypoglycemics (Choice C) is not appropriate for type 1 diabetes management. Scheduling a follow-up appointment in three months (Choice D) without intervening to improve diabetes control is not the best immediate action.

3. A mother brings her 3-month-old infant to the clinic because the baby does not sleep through the night. Which finding is most significant in planning care for this family?

• A. The mother is a single parent and lives with her parents
• B. The mother states the baby is irritable during feedings
• C. The infant's formula has been changed twice
• D. The diaper area shows severe skin breakdown

Correct answer: D

Rationale: Severe skin breakdown in the diaper area is significant as it indicates a potential severe issue that needs immediate attention to prevent further complications. Skin breakdown can lead to infections and discomfort for the infant, making it a priority in planning care for this family. The other findings, such as the mother's living situation, baby's irritability during feedings, or formula changes, are important but do not pose immediate risks to the infant's health compared to severe skin breakdown.

4. What action should the nurse implement when the infusion of chemotherapy via an implanted medication port is complete for a 16-year-old with acute myelocytic leukemia at the outpatient oncology clinic?

• A. Administer Zofran
• B. Obtain blood samples for RBCs, WBCs, and platelets
• C. Flush mediport with saline and heparin solution
• D. Initiate an infusion of normal saline

Correct answer: C

Rationale: The correct action for the nurse to implement when the chemotherapy infusion is complete is to flush the mediport with saline and heparin solution. This process helps prevent clotting and ensures the patency of the port, which is essential for future medication administrations and blood draws. Administering Zofran (Choice A) is not necessary after completing the chemotherapy infusion. Obtaining blood samples (Choice B) for RBCs, WBCs, and platelets is important but not the immediate action after completing the infusion. Initiating an infusion of normal saline (Choice D) is not required unless there is a specific indication for it.

5. Which nursing diagnosis is a priority for a 4-year-old child diagnosed with nephrotic syndrome?

• A. Impaired urinary elimination.
• B. Risk for infection.
• C. Fluid volume excess.
• D. Risk for impaired skin integrity.

Correct answer: C

Rationale: In a child with nephrotic syndrome, fluid volume excess is a priority nursing diagnosis due to the risk of edema and related complications. This patient may experience significant fluid retention, leading to edema, hypertension, and potential respiratory distress. Monitoring and managing fluid volume excess are crucial in preventing further complications and supporting the child's health during nephrotic syndrome. The other options are not the priority in this case. Impaired urinary elimination is not typically a primary concern in nephrotic syndrome. While infection is a risk due to compromised immunity, fluid volume excess poses a more immediate threat to the child's health. Risk for impaired skin integrity may be a concern secondary to edema, but addressing fluid volume excess takes precedence.

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