Nursing Elites

1. A parent brings a 2-month-old infant with Down syndrome to the pediatric clinic for a physical and administration of immunizations. Which clinical finding should alert the nurse to perform a further assessment?

• A. Flat occiput
• B. Small, low-set ears
• C. Circumoral cyanosis
• D. Protruding furrowed tongue

Correct answer: C

Rationale: Circumoral cyanosis should alert the nurse to perform further assessment in a 2-month-old infant with Down syndrome. This finding may indicate cardiac or respiratory issues, such as inadequate oxygenation. Small, low-set ears and a protruding furrowed tongue are common physical characteristics associated with Down syndrome and may not necessarily warrant immediate further assessment. A flat occiput is a normal variation in infant anatomy and is not typically a cause for immediate concern in this context.

2. A child with a diagnosis of nephrotic syndrome is being discharged. What dietary instructions should the nurse provide?

• A. Encourage a high-protein diet
• B. Avoid foods high in salt
• C. Encourage a low-sodium diet
• D. Encourage a low-protein diet

Correct answer: B

Rationale: For a child with nephrotic syndrome, it is important to avoid foods high in salt. This instruction helps manage symptoms and prevent complications associated with the condition. High salt intake can lead to fluid retention and worsen edema, which are common issues in nephrotic syndrome. Encouraging a low-sodium diet is crucial to maintaining fluid balance and reducing strain on the kidneys. Choices A, C, and D are incorrect because a high-protein diet can further stress the kidneys, while a low-protein diet may not be necessary unless specifically advised by the healthcare provider. Encouraging a low-sodium diet is more appropriate for managing nephrotic syndrome.

3. What is the first action a healthcare provider should take before administering a tube feeding to an infant?

• A. Irrigate the tube with water.
• B. Offer a pacifier to the infant.
• C. Slowly instill 10 mL of formula.
• D. Place the infant in the Trendelenburg position.

Correct answer: B

Rationale: The correct answer is to offer a pacifier to the infant before administering tube feeding. Offering a pacifier helps stimulate the sucking reflex, preparing the infant for feeding and promoting digestion and comfort. Irrigating the tube with water (Choice A) is not typically the first action before tube feeding and may not be necessary. Slowly instilling formula (Choice C) should only be done after the infant is prepared for feeding. Placing the infant in the Trendelenburg position (Choice D) is not necessary and may not be recommended for tube feeding.

4. The nurse is conducting a physical examination of a 9-month-old baby with a flat, discolored area on the skin. The nurse documents this as a:

• A. Papule
• B. Macule
• C. Vesicle
• D. Scale

Correct answer: B

Rationale: A macule is defined as a flat, discolored area on the skin that is different from surrounding tissue due to a change in color. In this case, the baby has a flat, discolored area on the skin, which fits the description of a macule. A papule is a small, raised solid bump, a vesicle is a small fluid-filled blister, and a scale is a flake of skin that is often dry and rough. Therefore, choices A, C, and D do not accurately describe the flat, discolored area on the baby's skin, making them incorrect.

5. A 3-year-old child with a history of frequent respiratory infections is being evaluated for cystic fibrosis. What diagnostic test should the nurse anticipate will be ordered?

• A. Chest X-ray
• B. Sweat chloride test
• C. Pulmonary function test
• D. Sputum culture

Correct answer: B

Rationale: The correct answer is the sweat chloride test. This test is crucial in diagnosing cystic fibrosis as it measures the amount of chloride in sweat, which is typically elevated in individuals with cystic fibrosis. A chest X-ray (Choice A) may show characteristic findings like hyperinflation or bronchiectasis, but it is not a definitive diagnostic test for cystic fibrosis. Pulmonary function tests (Choice C) may help assess lung function but are not specific for cystic fibrosis. Sputum culture (Choice D) may be used to identify specific pathogens causing respiratory infections but is not a primary diagnostic test for cystic fibrosis.

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