Nursing Elites

1. What characteristic indicates that a mass on a newborn's head is a cephalohematoma?

• A. The mass appears on the second day after birth.
• B. The mass grows larger when the newborn cries.
• C. The head appears asymmetrical.
• D. The mass is located on only one side of the head.

Correct answer: A

Rationale: A cephalohematoma typically appears between the first and second days after birth, making choice A the correct answer. It results from blood vessel rupture between a cranial bone and the periosteal membrane. Choices B, C, and D are incorrect because the growth of the mass when the newborn cries, asymmetrical head appearance, or the mass being located on only one side of the head are not specific indicators of a cephalohematoma.

2. During transport of a woman in labor, the patient tells you that she feels the urge to push. You assess her and see the top of the baby's head bulging from the vagina. What should you do?

• A. Ask the mother to take short, quick breaths until you arrive at the hospital.
• B. Allow the head to deliver and check for the location of the cord.
• C. Apply gentle pressure to the baby's head and notify the hospital immediately.
• D. Advise your partner to stop the ambulance and assist with the delivery.

Correct answer: D

Rationale: When the top of the baby's head is visible (crowning) during transport, it indicates imminent delivery. In this situation, it is crucial to stop the ambulance and assist with the delivery. This ensures a safe delivery process for the mother and the baby. Waiting to arrive at the hospital or attempting to apply pressure to the baby's head can lead to complications. Allowing the head to deliver and checking for the cord's location is a necessary step during the delivery process, but the immediate priority is to assist in the safe delivery of the baby.

3. General guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion include:

• A. placing the child supine and palpating the abdomen.
• B. separating the child from the parent to ensure a reliable examination.
• C. examining the child in the parent's arms.
• D. palpating the painful area of the abdomen first.

Correct answer: C

Rationale: When assessing a 2-year-old child with abdominal pain and adequate perfusion, it is essential to examine the child in the parent's arms. This approach can help maintain the child's comfort, keep them calm, and increase their cooperation during the assessment. Placing the child supine and palpating the abdomen (Choice A) can be distressing and uncomfortable for the child. Separating the child from the parent (Choice B) may cause additional stress and hinder the examination process. Palpating the painful area first (Choice D) can lead to increased discomfort and resistance from the child.

4. You are caring for a 6-year-old child with a possible fractured arm and have reason to believe that the child was abused. How should you manage this situation?

• A. Inform the parents of your suspicions.
• B. Transport the child to the hospital regardless of the parents' wishes.
• C. Call the police and have the parents arrested.
• D. Advise the parents that the child needs to be transported.

Correct answer: D

Rationale: In cases where child abuse is suspected, the priority is the safety and well-being of the child. Advising the parents that the child needs to be transported for further evaluation and care is the appropriate initial step. This ensures that the child receives necessary medical attention while also addressing the suspicion of abuse through proper channels. It is essential to involve appropriate authorities and follow established procedures to protect the child and investigate any potential abuse further.

5. How can the nurse best assess that the parents demonstrate understanding of the dressing change procedure prior to discharge for their child with burns?

• A. The parents explaining the importance of using sterile technique to the nurse.
• B. The nurse observing the parents changing the dressing using appropriate technique.
• C. The parents observing the nurse changing the dressing and confirming their understanding of the procedure.
• D. The nurse allowing the parents to explain the dressing change procedure and perform it in private to boost their confidence.

Correct answer: B

Rationale: The most effective way for the nurse to assess the parents' understanding of the dressing change procedure is by observing them as they change the dressing using the correct technique. This direct observation ensures that the parents are able to perform the task correctly and confidently before discharge. Merely verbalizing or explaining the procedure may not accurately reflect the parents' competency in performing the actual task. Choice A involves the parents explaining to the nurse, which does not directly assess their practical skills. Choice C suggests the parents observing the nurse, which does not evaluate the parents' ability to perform the task independently. Choice D focuses on boosting the parents' confidence but does not directly assess their understanding and competency in performing the dressing change.

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