Nursing Elites

1. A neonate with a meningomyelocele is scheduled for surgery in the morning. Which nursing action is appropriate for this neonate?

• A. Applying a diaper to prevent contamination of the sac
• B. Positioning the newborn in a side-lying position
• C. Encouraging the mother to hold the newborn because she will not be able to pick him up after surgery
• D. Positioning the newborn in a prone position

Correct answer: D

Rationale: Positioning the newborn in a prone position is appropriate for a neonate with a meningomyelocele before surgery. Placing the newborn in this position helps prevent pressure on the sac, reducing the risk of damaging it and promoting optimal surgical outcomes. Applying a diaper (choice A) may not be recommended as it can increase pressure on the sac. Positioning the newborn in a side-lying position (choice B) or encouraging the mother to hold the newborn (choice C) are not ideal actions before surgery as they do not address the specific needs of a neonate with a meningomyelocele.

2. A 4-year-old child is admitted to the hospital secondary to dehydration. Laboratory tests indicate a high hemoglobin and hematocrit, and the serum sodium is below normal levels. Which condition does the nurse suspect based on the current data?

• A. Hypernatremia
• B. Metabolic acidosis
• C. Hypotonic dehydration
• D. Isotonic dehydration

Correct answer: C

Rationale: The correct answer is hypotonic dehydration. The combination of high hemoglobin and hematocrit with low serum sodium indicates hypotonic dehydration. In this condition, there is an excess of solutes relative to water, leading to higher red blood cell concentration (elevated hemoglobin and hematocrit) and low serum sodium levels.

3. Which clean-catch urinalysis finding should raise the most concern for a child admitted to an urgent care center to rule out a urinary tract infection?

• A. 2+ white blood cells
• B. 1+ red blood cells
• C. Urine appearance: cloudy
• D. Specific gravity: 1.009

Correct answer: D

Rationale: A specific gravity of 1.009 is low, indicating diluted urine, which can be concerning in the context of a urinary tract infection. Diluted urine may suggest inadequate concentration due to increased fluid intake or impaired kidney function, which are important considerations in the assessment of a possible UTI.

4. A healthcare professional is performing hearing screenings for children at a community health fair. Which of the following children should the professional refer to a provider for a more extensive hearing evaluation?

• A. A toddler who is 18 months old and has unintelligible speech
• B. An infant who is 3 months old and has an exaggerated startle response
• C. A preschooler who is 4 years old and prefers playing with others rather than alone
• D. An infant who is 8 months old and is not yet making babbling sounds

Correct answer: D

Rationale: The healthcare professional should refer an infant who is not making babbling sounds by the age of 7 months to a provider for a more extensive evaluation of hearing. Babbling sounds are a developmental milestone that typically occurs by 7 months of age. Delayed or absent babbling can indicate potential hearing issues that warrant further assessment.

5. A caregiver is learning about administering digoxin to a toddler. Which statement by the caregiver indicates an understanding of the teaching?

• A. I will mix the medication with a small amount of juice.
• B. I will give the medication with meals.
• C. I will give a second dose if my child vomits.
• D. I will give my child water after giving the medication.

Correct answer: D

Rationale: The correct statement is D because giving the child water after administering digoxin helps ensure the medication is swallowed properly. Mixing the medication with juice (choice A) may affect its absorption. Giving the medication with meals (choice B) may interfere with its effectiveness. Administering a second dose if the child vomits (choice C) is not recommended as it may lead to an overdose.

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