Nursing Elites

1. When a mother of a 3-year-old boy gives birth to a baby girl and the boy asks why his baby sister is breastfeeding from their mother, how should the nurse respond? Select the option that is not appropriate.

• A. Remind him that his mother breastfed him too
• B. Clarify that breastfeeding is the mother's choice
• C. Reassure the older brother that it does not hurt his mother
• D. Explain that newborns get milk from their mothers in this way

Correct answer: B

Rationale: Choice B is not the appropriate response in this scenario. The correct answer is choice A, which normalizes the situation for the child by reminding him that his mother breastfed him too. This response helps the older brother understand that breastfeeding is a natural and common practice for newborns, including his baby sister, just as it was for him when he was a baby. Choice B, while true, does not directly address the child's question and may not provide the same level of reassurance and normalization as choice A. Choices C and D also do not directly answer the child's question and do not provide the same level of connection and understanding as choice A.

2. A 6-month-old female is scheduled to receive diphtheria, tetanus toxoid, and acellular pertussis vaccine (DTaP) and IPV (inactivated poliovirus vaccine) immunizations. She is recovering from a cold but is otherwise healthy and afebrile. Her 5-year-old sister is receiving chemotherapy. Which considerations should the nurse make for this situation?

• A. DTaP and IPV can be safely given to the infant at the scheduled time.
• B. DTaP and IPV are contraindicated because the infant has a cold.
• C. IPV is contraindicated because her sister is immunocompromised.
• D. DTaP is contraindicated because her sister is immunocompromised.

Correct answer: A

Rationale: DTaP and IPV can be safely administered to a child with a mild illness like a cold, even if there is an immunocompromised family member, as these vaccines do not contain live viruses. It is important to ensure that the child is otherwise healthy and afebrile before administering the vaccines. The presence of a cold is not a contraindication for receiving DTaP and IPV vaccines. Choice A is correct because the infant can receive both vaccines as scheduled. Choice B is incorrect as having a cold does not contraindicate DTaP and IPV administration. Choice C is incorrect because IPV is not contraindicated due to the sister's immunocompromised status. Choice D is incorrect as both DTaP and IPV can be given in this scenario.

3. The practical nurse is caring for a child with suspected appendicitis. Which assessment finding should be reported to the healthcare provider immediately?

• A. Nausea and vomiting.
• B. Sudden relief of pain.
• C. Low-grade fever.
• D. Rebound tenderness.

Correct answer: B

Rationale: Sudden relief of pain in a child with suspected appendicitis should be reported immediately as it may indicate a rupture of the appendix, which is a medical emergency. Sudden relief of pain is concerning because it can be a sign of a perforated appendix, leading to peritonitis and sepsis.

4. A mother brings her 3-week-old infant to the clinic because the baby vomits after eating and always seems hungry. Further assessment indicates that the infant’s vomiting is projectile, and the child seems listless. Which additional assessment finding indicates the possibility of a life-threatening complication?

• A. Irregular palpable pulse
• B. Hyperactive bowel sounds
• C. Underweight for age
• D. Crying without tears

Correct answer: D

Rationale: In this scenario, the infant presenting with vomiting, lethargy, and projectile vomiting indicates a potential serious condition. Crying without tears is a sign of dehydration, a critical condition that can lead to life-threatening complications in infants. Dehydration can rapidly worsen an infant's condition, making prompt intervention crucial to prevent further complications. Irregular palpable pulse (Choice A) could indicate a cardiovascular issue but is less immediately life-threatening in this context. Hyperactive bowel sounds (Choice B) are more indicative of gastrointestinal issues rather than a life-threatening complication. Underweight for age (Choice C) may be concerning for growth-related issues but does not directly indicate a life-threatening complication like dehydration does.

5. A child diagnosed with Kawasaki disease is brought to the clinic. The mother reports that her child is irritable, refuses to eat, and has skin peeling on both hands and feet. Which intervention should the nurse instruct the mother to implement first?

• A. Place the child in a quiet environment
• B. Make a list of foods that the child likes
• C. Encourage the parents to rest when possible
• D. Apply lotion to hands and feet

Correct answer: A

Rationale: The correct intervention for a child with Kawasaki disease, presenting with irritability and skin peeling, is to place the child in a quiet environment. This helps reduce environmental stimuli, calming the child and aiding in managing the symptoms associated with the disease. Choice B is incorrect as addressing food preferences is not the priority in this situation. Choice C is incorrect as the focus should be on the child's immediate needs. Choice D is incorrect as applying lotion is not the first-line intervention for Kawasaki disease symptoms.

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