Nursing Elites

1. A newborn with an anorectal anomaly had an anoplasty performed. At the 2-week follow-up visit, a series of anal dilations is begun. What should the nurse recommend to the parents to help prevent the infant from becoming constipated?

• A. Use a soy formula if necessary.
• B. Breastfeed if possible.
• C. Avoid administering a suppository nightly.
• D. Do not offer glucose water between feedings.

Correct answer: B

Rationale: Breastfeeding is recommended to help prevent constipation in infants due to the easily digestible nature of breast milk, which often leads to softer stools. Breastfeeding is preferred over formula feeding as it provides optimal nutrition for the infant's digestive system. Choice A, using a soy formula if necessary, may be considered only if there are specific dietary concerns or allergies; however, breast milk is still the preferred option. Choice C, avoiding administering a suppository nightly, is correct as it is not a routine method for preventing constipation in infants and may not be appropriate without medical advice. Choice D, not offering glucose water between feedings, is recommended as it may not address the root cause of constipation and may introduce unnecessary sugar to the infant's diet.

2. A 7-year-old child with a history of seizures is being discharged from the hospital. What should the nurse include in the discharge teaching for the parents?

• A. Administer antiepileptic medication as prescribed, not just when a seizure occurs
• B. Ensure the child gets adequate sleep
• C. Restrict the child's activities to prevent seizures
• D. Teach seizure first aid to family members

Correct answer: D

Rationale: The correct answer is to teach seizure first aid to family members. This is crucial because family members need to know how to appropriately respond during a seizure to ensure the child's safety. Choice A has been corrected to emphasize that antiepileptic medication should be administered as prescribed, not just when a seizure occurs, to effectively manage the condition. Choice B, while important for overall health, is not directly related to seizure management. Choice C is not recommended as restricting activities may not prevent seizures and may hinder the child's quality of life.

3. The school nurse is presenting a class to a group of students about common overuse disorders. Which disorder would the school nurse include?

• A. Dislocated radial head
• B. Transient synovitis of the hip
• C. Osgood-Schlatter disease
• D. Scoliosis

Correct answer: C

Rationale: The correct answer is C: Osgood-Schlatter disease. This condition is a common overuse injury that affects the knee. Osgood-Schlatter disease typically occurs in children and adolescents who are involved in activities that require frequent running, jumping, and kicking. It is characterized by pain, swelling, and tenderness at the tibial tuberosity, where the patellar tendon inserts into the tibia. Choice A, Dislocated radial head, is not an overuse disorder but rather a form of elbow injury where the head of the radius bone is displaced from its normal position. Choice B, Transient synovitis of the hip, is a self-limiting condition that causes hip pain and limping in children. It is not typically considered an overuse disorder. Choice D, Scoliosis, is a condition characterized by an abnormal lateral curvature of the spine. While it may be related to certain activities or postures, it is not primarily classified as an overuse disorder.

4. Which observation made of the exposed abdomen is most indicative of pyloric stenosis?

• A. abdominal rigidity
• B. substernal retraction
• C. palpable olive-like mass
• D. marked distention of lower abdomen

Correct answer: C

Rationale: The correct answer is C: palpable olive-like mass. In pyloric stenosis, a palpable olive-like mass can often be felt in the abdomen due to the hypertrophied pyloric muscle. This mass is a key characteristic finding in infants with pyloric stenosis. Choice A, abdominal rigidity, is more commonly associated with conditions like peritonitis. Choice B, substernal retraction, is not typically seen in pyloric stenosis but can be a sign of respiratory distress. Choice D, marked distention of the lower abdomen, is not specific to pyloric stenosis and can be present in various abdominal conditions.

5. The nurse is caring for a boy with probable intussusception. He had diarrhea before admission, but while waiting for the administration of air pressure to reduce the intussusception, he passes a normal brown stool. Which nursing action is the most appropriate?

• A. notify the practitioner
• B. measure abdominal girth
• C. auscultate for bowel sounds
• D. take vital signs, including blood pressure

Correct answer: A

Rationale: The passage of a normal brown stool in a child with intussusception could indicate spontaneous reduction of the intussusception. This change in the patient's condition is significant, requiring prompt notification of the practitioner for further evaluation and management. While measuring abdominal girth (Choice B) is important for assessing abdominal distention, it is not the priority when a potential spontaneous reduction may have occurred. Auscultating for bowel sounds (Choice C) and taking vital signs, including blood pressure (Choice D), are routine nursing assessments but do not address the immediate need to inform the practitioner of a possible change in the patient's condition that necessitates urgent attention.

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