Nursing Elites

1. When preparing to insert an intravenous catheter for a 7-year-old child, which of the following actions should a healthcare professional take?

• A. Apply an anesthetic cream to the insertion site 1 hr before the procedure.
• B. Use a 16-gauge needle for the insertion.
• C. Insert the catheter into a vein of the child's dominant hand.
• D. Choose a site over the child's metacarpal veins.

Correct answer: A

Rationale: Applying an anesthetic cream to the insertion site 1 hr before the procedure is crucial when inserting an intravenous catheter in a child to minimize pain and discomfort during the procedure. This practice is especially important in pediatric patients to ensure a more comfortable experience and improve cooperation during the insertion process. Choice B is incorrect as a 16-gauge needle is too large for a child, and a smaller gauge needle is typically used. Choice C is incorrect as the catheter should be inserted into a suitable vein, not specifically the dominant hand vein. Choice D is incorrect as metacarpal veins are usually avoided due to their small size and the potential for complications.

2. Which assessment finding for a 4-month-old infant would require further action by the nurse?

• A. The posterior fontanel is open.
• B. The infant has good head control when held upright.
• C. The infant is able to roll only from abdomen to back.
• D. The anterior fontanel is open and soft.

Correct answer: A

Rationale: The correct answer is A. The posterior fontanel should be closed by 4 months of age. An open posterior fontanel at this age may indicate a delay in normal closure, which could be a cause for concern and require further evaluation by the healthcare provider to ensure proper development and growth. Choices B, C, and D are typical developmental milestones for a 4-month-old infant and do not raise immediate concerns requiring further action by the nurse.

3. A healthcare professional is preparing for the delivery of a newborn with a known diaphragmatic hernia defect. Which equipment should the professional have on hand for the delivery?

• A. Bag-valve-mask system
• B. Sterile gauze and saline
• C. Soft arm restraints
• D. Endotracheal tube

Correct answer: D

Rationale: An endotracheal tube is crucial for managing the airway of a newborn with a diaphragmatic hernia. In this condition, there may be respiratory distress due to incomplete development of the diaphragm, allowing abdominal organs to move into the chest cavity and compress the lungs. The endotracheal tube helps in securing the airway and providing respiratory support if needed until definitive treatment can be initiated.

4. The nurse is unsuccessful in inserting a nasogastric tube for a newborn client. The nurse suspects the newborn has esophageal atresia/tracheoesophageal (EA/TE) fistula. Which nursing action is appropriate while waiting for the healthcare provider to further assess the neonate?

• A. Position the newborn in a semi-Fowler position.
• B. Allow the newborn to stay in the nursery for observation.
• C. Offer the newborn pacifier for comfort.
• D. Wrap the newborn in blankets and place in an incubator.

Correct answer: A

Rationale: Positioning the newborn in a semi-Fowler position is appropriate as it helps prevent aspiration in suspected EA/TE fistula. This position helps reduce the risk of regurgitation and aspiration of gastric contents. Placing the newborn in a semi-Fowler position promotes the drainage of secretions and reduces the risk of complications while awaiting further assessment by the healthcare provider.

5. A healthcare provider is assessing an infant who has hydrocephalus and is 6 hours postoperative following placement of a ventriculoperitoneal shunt. Which of the following findings should the provider report to the healthcare provider?

• A. Decreased urine output
• B. Temperature of 37.5 degrees C (99.5 degrees F)
• C. Heart rate 130/min
• D. Leakage of cerebrospinal fluid

Correct answer: D

Rationale: The provider should report the leakage of cerebrospinal fluid to the healthcare provider as it may indicate shunt malfunction or infection, requiring immediate attention to prevent complications. Decreased urine output, a temperature of 37.5 degrees C, and a heart rate of 130/min are common postoperative findings and may not be directly related to shunt function. While these findings should still be monitored, they do not require immediate reporting like cerebrospinal fluid leakage.

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