Nursing Elites

1. A mother who has never breastfed a child before is having trouble getting the baby to latch on to the breast. The baby has lost 3% of its birth weight within the first 2 days of life. The best statement is:

• A. The baby will eventually take to the breast.
• B. I can prepare a bottle if you want to try that.
• C. A small amount of weight loss in the first few days is normal.
• D. I can arrange for the charge nurse to come and talk to you about breastfeeding.

Correct answer: C

Rationale: The correct answer is 'A small amount of weight loss in the first few days is normal.' It is important to reassure the mother that a small amount of weight loss, such as 5-10% of birth weight, in the first few days of life is considered normal for newborns. This reassurance helps alleviate the mother's concerns. Option A is incorrect because it does not address the concern about weight loss; it focuses more on the baby eventually latching on. Option B is not recommended as the first solution for breastfeeding issues, as introducing a bottle early on may lead to nipple confusion. Option D involves escalating the situation to the charge nurse when it can be addressed by providing appropriate information and support directly, making it less necessary in this scenario where reassurance and education are key.

2. A nurse is taking the health history of an 85-year-old client. Which of the following physical findings is consistent with normal aging?

• A. Increase in subcutaneous fat.
• B. Diminished cough reflex.
• C. Long-term memory loss.
• D. Myopia.

Correct answer: B

Rationale: The correct answer is 'Diminished cough reflex.' Diminished cough reflex is a physical finding consistent with normal aging in older adults, which can increase the risk of aspiration and atelectasis. An increase in subcutaneous fat actually raises the risk of pressure ulcers. While long-term memory is typically preserved in aging unless affected by dementia, short-term memory often declines. Myopia (near-sightedness) is common in younger individuals, but presbyopia (far-sightedness) is more common with aging. Additionally, individuals with myopia may experience an improvement in vision as they age.

3. After applying oxygen using bi-nasal prongs to a client who is having chest pain, the nurse should implement which intervention?

• A. Have the client take slow deep breaths in through their mouth and out through their nose.
• B. Post signs indicating that oxygen is in use on the client's door and in their room
• C. Apply Vaseline petroleum to both nares and 2 by 2 gauze around the oxygen tubing at the client's ears
• D. Encourage the client to hyperextend the neck, take a few deep breaths and cough.

Correct answer: A

Rationale: After applying oxygen using bi-nasal prongs to a client with chest pain, it is essential for the nurse to post signs indicating that oxygen is in use on the client's door and in their room. This safety precaution alerts healthcare providers and visitors that the client is receiving oxygen therapy, reducing the risk of accidents or misunderstandings. Choice A is incorrect because instructing the client to take slow deep breaths is not the appropriate intervention after applying oxygen. Choice C suggests applying Vaseline and gauze, which is unnecessary and not a standard practice. Choice D advising the client to hyperextend the neck, take deep breaths, and cough is not indicated after applying oxygen therapy and could potentially be harmful.

4. Signs of impaired breathing in infants and children include all of the following except:

• A. nasal flaring
• B. grunting
• C. seesaw breathing
• D. quivering lips

Correct answer: D

Rationale: Signs of impaired breathing in infants and children can manifest in various ways. Nasal flaring, grunting, and seesaw breathing are all indicative of respiratory distress in pediatric patients. Nasal flaring is the widening of the nostrils with breathing effort, grunting is a sound made during exhalation to try to keep the airways open, and seesaw breathing involves the chest moving in the opposite direction of the abdomen. However, quivering lips are not typically associated with impaired breathing in this context. Lip quivering is a distracter and not a common sign of respiratory distress in infants and children. Therefore, the correct answer is 'quivering lips.'

5. A client with sickle cell disease is worried about passing the disease on to children. Which of the following statements by the PN is most appropriate for this client?

• A. "You should discuss the inheritance risk with your physician."?
• B. "Sickle cell disease is genetically based and might be passed on to children."?
• C. "Sickle cell disease is genetically based and is not passed on to children."?
• D. "Sickle cell disease is caused by an infection and cannot be passed on to children."?

Correct answer: B

Rationale: A client with sickle cell disease has a genetic condition that can be passed on to their offspring. The most appropriate statement for the PN to provide is to acknowledge this fact and inform the client that sickle cell disease is genetically based and might be passed on to children. This empowers the client with accurate information. Choice A has been refined to emphasize discussing the inheritance risk, making it a better option than the vague original choice. Choices C and D provide incorrect information. Sickle cell disease is indeed genetically based and can be inherited.

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