Nursing Elites

1. An infant has just returned from surgery for placement of a gastrostomy tube as an initial treatment for tracheoesophageal fistula. The mother asks, 'When can the tube be used for feeding?' The nurse's best response would be which of these comments?

• A. "Feedings can begin in 5 to 7 days."
• B. "The use of the feeding tube can begin immediately."
• C. "The stomach contents and air must be drained first."
• D. "The incision healing must be complete before feeding."

Correct answer: C

Rationale: The correct answer is C: 'The stomach contents and air must be drained first.' Before starting feedings through a gastrostomy tube, it is essential to drain the stomach contents and air. This process helps prevent complications and ensures the proper functioning of the tube after placement. Choice A is incorrect because initiating feedings within 5 to 7 days may lead to complications if the stomach is not adequately prepared. Choice B is incorrect as feeding should not begin immediately to allow for proper preparation of the tube and the stomach. Choice D is incorrect because although incision healing is important, draining the stomach contents and air is a more immediate concern to prevent complications.

2. During a home visit for a family with a new baby, what should the nurse assess first?

• A. feeding patterns
• B. sleeping arrangements
• C. support system
• D. immunization status

Correct answer: A

Rationale: Assessing feeding patterns is the priority during a home visit for a family with a new baby because it is crucial for the health and growth of the newborn. By evaluating the feeding patterns, the nurse can ensure that the baby is receiving adequate nutrition and address any feeding issues promptly. While sleeping arrangements, support system, and immunization status are important aspects to assess during a home visit, they are not as critical as ensuring the newborn's nutritional needs are being met.

3. The nurse is caring for a 4-year-old child with a greenstick fracture. In explaining this type of fracture to the parents, the best response by the nurse should be that

• A. A child's bone is more flexible and can be bent 45 degrees before breaking
• B. Bones of children are more porous than adults and often have incomplete breaks
• C. Compression of porous bones produces a buckle or torus type break
• D. Bone fragments often remain attached by a periosteal hinge

Correct answer: B

Rationale: The correct answer is B. Greenstick fractures are common in children because their bones are softer and more porous than adult bones, leading to incomplete breaks when force is applied. Choice A is incorrect as greenstick fractures are not due to bone flexibility but rather the porous nature of children's bones. Choice C is incorrect as it describes a buckle or torus type break, which is not characteristic of a greenstick fracture. Choice D is incorrect as greenstick fractures do not involve bone fragments remaining attached by a periosteal hinge.

4. Which of the following strategies is most effective in promoting breastfeeding in a community?

• A. Providing formula samples
• B. Offering breastfeeding education and support
• C. Encouraging early weaning
• D. Promoting bottle feeding

Correct answer: B

Rationale: The most effective strategy in promoting breastfeeding in a community is offering breastfeeding education and support. This helps mothers learn about the benefits of breastfeeding, gain confidence in their ability to breastfeed, and receive necessary support to overcome challenges. Providing formula samples (Choice A) can undermine breastfeeding efforts by promoting formula feeding over breastfeeding. Encouraging early weaning (Choice C) goes against the recommendation of exclusive breastfeeding for the first six months of life. Promoting bottle feeding (Choice D) can deter mothers from initiating or continuing breastfeeding, leading to decreased breastfeeding rates.

5. James is an 18-month-old child who has had a cough for 7 days with no general danger signs, a temperature of 37.5°C, and a respiratory rate of 41 breaths per minute. How will you classify James' breathing?

• A. Slow breathing
• B. Fast breathing
• C. Normal breathing
• D. Very fast breathing

Correct answer: C

Rationale: The correct answer is 'Normal breathing.' A respiratory rate of 41 breaths per minute is considered normal for an 18-month-old child. Choices A, B, and D are incorrect because a respiratory rate of 41 breaths per minute falls within the normal range for a child of James' age and does not indicate slow, fast, or very fast breathing.

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