Nursing Elites

1. A nurse is caring for an infant born with exstrophy of the bladder. What does the nurse determine is the greatest risk for this infant?

• A. Infection
• B. Dehydration
• C. Urinary retention
• D. Intestinal obstruction

Correct answer: A

Rationale: Infection is the greatest risk for an infant with exstrophy of the bladder due to the exposure of the bladder and surrounding tissues. The bladder mucosa and adjacent tissues being exposed increase the susceptibility to infections. Dehydration (Choice B) is not the primary concern in this condition. Urinary retention (Choice C) is less likely as exstrophy of the bladder usually presents with constant dribbling of urine. Intestinal obstruction (Choice D) is not directly related to exstrophy of the bladder.

2. After corrective surgery for hypertrophic pyloric stenosis (HPS), what should the nurse teach a parent to do immediately after a feeding to limit vomiting?

• A. Rock the infant.
• B. Place the infant in an infant seat.
• C. Place the infant flat on the right side.
• D. Keep the infant awake with sensory stimulation.

Correct answer: B

Rationale: After corrective surgery for hypertrophic pyloric stenosis (HPS), placing the infant in an infant seat is the correct action to take immediately after feeding to limit vomiting. This position helps keep the head elevated, reducing the risk of vomiting. Rocking the infant (Choice A) may agitate the stomach and increase the likelihood of vomiting. Placing the infant flat on the right side (Choice C) is not recommended as it does not encourage proper digestion and may increase the risk of vomiting. Keeping the infant awake with sensory stimulation (Choice D) does not address the positioning concern related to vomiting in this specific post-operative scenario.

3. Parents of a sick infant talk with a nurse about their baby. One parent says, “I am so upset; I didn’t realize our baby was ill.” What major indication of illness in an infant should the nurse explain to the parent?

• A. Grunting respirations
• B. Excessive perspiration
• C. Longer periods of sleep
• D. Crying immediately after feedings

Correct answer: C

Rationale: The correct answer is C. Longer periods of sleep than usual can be a sign of illness in infants. When an infant sleeps more than usual, it can indicate that the baby is conserving energy due to an underlying condition. Grunting respirations (choice A) can be a sign of respiratory distress, not just an indication of illness. Excessive perspiration (choice B) can occur due to various reasons and is not a specific major indication of illness. Crying immediately after feedings (choice D) is a common behavior in infants and not necessarily a major indication of illness.

4. A nurse is teaching the parents of a child with a diagnosis of type 1 diabetes mellitus about blood glucose monitoring. What should the nurse emphasize?

• A. Checking blood glucose levels before meals and at bedtime
• B. Using a lancet device to obtain blood samples
• C. Using urine test strips for monitoring
• D. Recognizing signs of hypoglycemia

Correct answer: A

Rationale: Checking blood glucose levels before meals and at bedtime is essential in managing type 1 diabetes mellitus as it helps in monitoring blood sugar levels at different times of the day and adjusting insulin doses accordingly. Option B about using a lancet device to obtain blood samples is a technique rather than an emphasis on monitoring frequency. Option C suggesting the use of urine test strips is incorrect as urine test strips are not recommended for accurate real-time monitoring of blood glucose levels in type 1 diabetes. Option D, recognizing signs of hypoglycemia, is important but not the primary emphasis when educating about blood glucose monitoring.

5. A child is admitted with extensive burns. The nurse notes burns on the child’s lips and singed nasal hairs. The nurse should suspect that the child has a(n)

• A. chemical burn
• B. inhalation injury
• C. electrical burn
• D. hot-water scald

Correct answer: B

Rationale: Burns on the lips and singed nasal hairs indicate inhalation injury, suggesting the child has inhaled hot gases or smoke. This presentation is common in cases where the respiratory tract is exposed to hot gases or smoke, leading to potential airway compromise. Choice A, chemical burn, is incorrect because there is no mention of exposure to chemicals, and the symptoms described are more indicative of inhalation injury. Choice C, electrical burn, is incorrect as there is no evidence of electrical involvement in the scenario provided. Choice D, hot-water scald, is incorrect because the presence of singed nasal hairs points more towards inhalation injury than a scald from hot water, emphasizing the need to prioritize airway management and respiratory support.

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