Nursing Elites

1. A healthcare professional is reviewing the laboratory report of a child with tetralogy of Fallot that indicates an elevated RBC count. What does the professional identify as the cause of the polycythemia?

• A. Low tissue oxygen needs
• B. Tissue oxygen needs
• C. Diminished iron level
• D. Hypertrophic cardiac muscle

Correct answer: B

Rationale: The correct answer is B: Tissue oxygen needs. Polycythemia occurs as the body's response to chronic hypoxia by increasing RBC production to enhance oxygen delivery. In tetralogy of Fallot, a congenital heart defect, the heart's structure causes reduced oxygen levels in the blood. This chronic hypoxia stimulates the bone marrow to produce more red blood cells, leading to an elevated RBC count. Choice A is incorrect as low blood pressure is not directly related to polycythemia in this context. Choice C, diminished iron level, is not the cause of polycythemia in tetralogy of Fallot. Choice D, hypertrophic cardiac muscle, is not the primary cause of the elevated RBC count in this case.

2. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

• A. begin positive pressure ventilations
• B. provide blow-by oxygen with oxygen tubing
• C. assess the newborn's skin condition and color
• D. start chest compressions and contact medical control

Correct answer: A

Rationale: A heart rate below 100 beats/min in a newborn indicates the need for positive pressure ventilation to improve oxygenation. Providing positive pressure ventilations helps in assisting the newborn's breathing efforts to ensure adequate oxygenation. Choice B, providing blow-by oxygen, may not be sufficient to address the underlying issue of inadequate breathing. Choice C, assessing the newborn's skin condition and color, is important but not the most immediate action needed for a heart rate below 100 beats/min. Choice D, starting chest compressions, is not indicated as the infant is breathing spontaneously and has a heart rate, albeit lower than normal, which does not warrant chest compressions.

3. At 0345, you receive a call for a woman in labor. Upon arriving at the scene, you are greeted by a very anxious man who tells you that his wife is having her baby 'now.' This man escorts you into the living room where a 25-year-old woman is lying on the couch in obvious pain. Which of the following statements regarding crowning is true?

• A. Crowning represents the end of the second stage of labor.
• B. Crowning always occurs immediately after the amniotic sac has ruptured.
• C. It is safe to transport the patient during crowning if the hospital is close.
• D. Gentle pressure should be applied to the baby's head during crowning.

Correct answer: D

Rationale: During crowning, it is important to apply gentle pressure to the baby's head. This helps to prevent rapid delivery, which can lead to tearing and other complications for both the mother and the baby. Applying pressure also helps to control the delivery process, ensuring a safer and more controlled birth. Choices A, B, and C are incorrect because crowning does not signify the end of the second stage of labor, does not always occur immediately after the amniotic sac ruptures, and it is not safe to transport the patient during crowning, especially if the hospital is nearby, as rapid delivery can occur.

4. What is the typical therapeutic management treatment for children with Hirschsprung disease?

• A. Daily enemas
• B. Low-fiber diet
• C. Permanent colostomy
• D. Surgical removal of affected section of bowel

Correct answer: D

Rationale: The most common treatment for Hirschsprung disease is the surgical removal of the affected section of the bowel. This procedure entails excising the part of the colon that lacks nerve cells crucial for normal bowel function. Daily enemas (Choice A) can offer temporary relief for constipation but do not address the root cause of the condition, which is the absence of nerve cells. A low-fiber diet (Choice B) is not a primary therapy for Hirschsprung disease and may not effectively manage the disorder. A permanent colostomy (Choice C) is typically considered in severe cases where other interventions have failed and is not the standard management approach for Hirschsprung disease.

5. The parents of a child with asthma ask the nurse how they can help their child prevent asthma attacks. What should the nurse advise?

• A. Avoid exposure to allergens
• B. Encourage regular exercise
• C. Provide a high-protein diet
• D. Increase fluid intake

Correct answer: A

Rationale: The correct answer is to advise the parents to avoid exposure to allergens. Asthma attacks are often triggered by allergens such as dust mites, pollen, pet dander, and mold. By minimizing the child's exposure to these triggers, the likelihood of asthma attacks can be reduced. Encouraging regular exercise is beneficial for overall health but may not directly prevent asthma attacks. Providing a high-protein diet and increasing fluid intake are important for general well-being but do not specifically address asthma prevention.

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