Nursing Elites

1. After reinforcing information on treating a sprained ankle, what statement by the adolescent indicates to the practical nurse that further instruction is needed?

• A. Keep the leg elevated when sitting.
• B. Wrap the ankle in an elastic bandage for support.
• C. Apply warm compresses to the ankle for the first 24 hours.
• D. Put an ice pack on the ankle, alternating 30 minutes on and 30 minutes off.

Correct answer: C

Rationale: The correct answer is C. Applying warm compresses to a sprained ankle within the first 24 hours is incorrect as it can increase swelling and inflammation. Instead, cold compresses are recommended to help reduce swelling and pain. Option A, keeping the leg elevated, helps in reducing swelling. Option B, wrapping the ankle in an elastic bandage, provides support. Option D, using an ice pack in intervals, is effective in reducing swelling and pain. Therefore, the statement about applying warm compresses indicates the need for further instruction.

2. When should the surgical correction of hypospadias in a newborn infant typically be done?

• A. Repair should be done by one month to prevent bladder infection.
• B. To form a proper urethra repair, it should be done after sexual maturity.
• C. Repairs typically should be done before the child is potty trained.
• D. Delaying the repair until school age reduces castration fears.

Correct answer: C

Rationale: Surgical repairs for hypospadias are typically recommended to be performed before the child is potty trained. This timing helps in avoiding complications, ensures better outcomes, and makes the surgical process smoother. Early correction also minimizes the psychological impact on the child regarding genital differences and can improve long-term psychological well-being. Choices A, B, and D are incorrect because repairing hypospadias at one month to prevent bladder infection, after sexual maturity to form a proper urethra, or delaying the repair until school age to reduce castration fears are not the standard recommendations. The optimal timing for surgical correction is before the child is potty trained to achieve the best results and psychological outcomes.

3. The mother of a one-month-old calls the clinic to report that the back of her infant's head is flat. How should the nurse respond?

• A. Turn the infant on the left side braced against the crib when sleeping.
• B. Prop the infant in a sitting position with a cushion when not sleeping.
• C. Place a small pillow under the infant's head while lying on the back.
• D. Position the infant on the stomach occasionally when awake and active.

Correct answer: D

Rationale: Positioning the infant on the stomach occasionally when awake and active can help prevent flat spots on the head. This position allows for more natural movement and prevents prolonged pressure on one area of the head, reducing the risk of developing a flat spot. Turning the infant on the left side braced against the crib when sleeping (choice A) is not recommended as it does not address the issue of flat spots. Propping the infant in a sitting position with a cushion when not sleeping (choice B) may increase the risk of falls and is not suitable for a one-month-old. Placing a small pillow under the infant's head while lying on the back (choice C) should be avoided due to the risk of suffocation and sudden infant death syndrome (SIDS).

4. The parents of a 2-month-old infant, who is being discharged after treatment for pyloric stenosis, are being educated by the healthcare provider. Which statement by the parents indicates a need for further teaching?

• A. We should feed our baby in an upright position
• B. We should avoid feeding our baby solid foods until at least 6 months of age
• C. We will lay our baby on their stomach to sleep
• D. We will burp our baby frequently during feedings

Correct answer: C

Rationale: The correct answer is C. Placing babies on their stomach to sleep increases the risk of sudden infant death syndrome (SIDS). The safest sleep position for infants is on their back to reduce the risk of SIDS. Teaching parents about safe sleep practices is crucial in preventing potential harm to the infant. Choices A, B, and D are all correct statements that promote the well-being of the infant. Feeding the baby in an upright position helps prevent reflux, delaying solid foods until 6 months of age is recommended for proper growth and development, and burping the baby frequently during feedings helps prevent gas buildup and colic.

5. A 4-month-old girl is brought to the clinic by her mother because she has had a cold for 2 or 3 days and woke up this morning with a hacking cough and difficulty breathing. Which additional assessment finding should alert the nurse that the child is in acute respiratory distress?

• A. Bilateral bronchial breath sounds.
• B. Diaphragmatic breathing.
• C. A resting respiratory rate of 35 breaths per minute.
• D. Flaring of the nares.

Correct answer: D

Rationale: Flaring of the nares is a classic sign of acute respiratory distress in infants. It indicates increased work of breathing and is a visible cue that the child is struggling to breathe. This finding should alert healthcare providers to the severity of the respiratory distress and the need for prompt intervention to support the child's breathing. Choices A, B, and C are incorrect. Bilateral bronchial breath sounds are associated with conditions like pneumonia, but they do not specifically indicate acute respiratory distress. Diaphragmatic breathing is a normal breathing pattern and not a sign of distress. A resting respiratory rate of 35 breaths per minute is within the expected range for a 4-month-old infant and does not necessarily indicate acute respiratory distress.

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