Nursing Elites

1. An infant is suspected of having esophageal atresia/tracheoesophageal fistula. While waiting for the pediatrician to see the infant, which action should the nurse take?

• A. Position the infant with the head of the bed slightly elevated
• B. Allow the infant to bond with the mother in her room
• C. Offer the infant breastfeeding instead of formula feeding
• D. Wrap the infant in blankets and place in a crib by the viewing window

Correct answer: A

Rationale: Positioning the infant with the head of the bed elevated helps to prevent aspiration and manage secretions until further treatment can be provided. Choice B is incorrect as the priority is ensuring the infant's safety and health, not immediate bonding. Choice C is incorrect as breastfeeding may worsen the condition. Choice D is incorrect as it does not address the potential risk of aspiration associated with esophageal atresia/tracheoesophageal fistula.

2. A four-year-old boy is admitted to the hospital with leg pain and fever. He is pale-looking and has bruises over various areas of his body. The physician suspects acute lymphoblastic leukemia (ALL). Which test would be used to confirm the diagnosis?

• A. Bone marrow aspirate
• B. Red blood cell count
• C. Lumbar puncture
• D. Bone scan

Correct answer: A

Rationale: A bone marrow aspirate is the definitive test to confirm acute lymphoblastic leukemia (ALL) in this case. It allows for the examination of leukemic cells in the bone marrow, providing a direct assessment of the disease. Red blood cell count (Choice B) is not specific for diagnosing leukemia but may show anemia commonly seen in leukemia patients. Lumbar puncture (Choice C) is used to assess central nervous system involvement, not primarily for confirming ALL. Bone scan (Choice D) is not a standard diagnostic test for ALL and is mainly used for evaluating bone metastases in other conditions.

3. Children may believe that they are responsible for their parents' divorce and interpret the separation as punishment. At which age is this most likely to occur?

• A. 1 year
• B. 4 years
• C. 8 years
• D. 13 years

Correct answer: C

Rationale: At around 8 years old, children may feel they are responsible for their parents' divorce and view it as a punishment, which can impact their emotional well-being.

4. The nurse is discussing sexually transmitted infections (STIs) with a 17-year-old student. Which cognitive development theory should the teaching plan be based on?

• A. Sensorimotor reactions
• B. Limited cause and effect understanding
• C. Abstract thinking
• D. Concrete thinking

Correct answer: C

Rationale: The correct answer is C: 'Abstract thinking.' According to Piaget’s theory of cognitive development, adolescents, typically around the age of 12 and older, enter the formal operational stage where they can think abstractly and reason about hypothetical situations. When discussing complex topics like STIs with a 17-year-old student, it is essential to base the teaching plan on abstract thinking. Choice A, 'Sensorimotor reactions,' is incorrect as it pertains to the earliest stage in Piaget's theory (birth to 2 years old) focusing on sensory experiences and physical interactions. Choice B, 'Limited cause and effect understanding,' does not align with the cognitive abilities of a 17-year-old who is capable of more advanced thinking. Choice D, 'Concrete thinking,' is also incorrect as it refers to the stage before formal operations, where individuals think more concretely and struggle with abstract concepts.

5. Which finding suggests fluid volume deficit in an infant presenting with vomiting and diarrhea for 2 days?

• A. Increased blood pressure
• B. A sunken fontanel
• C. Decreased pulse rate
• D. Low urine specific gravity

Correct answer: B

Rationale: A sunken fontanel is a classic sign of dehydration in infants, indicating a fluid volume deficit. In dehydration, the fontanel sinks due to decreased fluid volume in the body. Increased blood pressure (Choice A) is not typically associated with dehydration in infants. Decreased pulse rate (Choice C) is not a common finding in fluid volume deficit, as the body tries to increase the heart rate to compensate for decreased volume. Low urine specific gravity (Choice D) may be seen in dehydration, but it is not as specific or as easily observable as a sunken fontanel.

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