Nursing Elites

1. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care would include what?

• A. Monitor closely for signs of infection.
• B. Place the child with the operative side of the head up.
• C. Avoid pumping the shunt reservoir to maintain patency.
• D. Avoid maintaining a Trendelenburg position to decrease pressure on the shunt.

Correct answer: A

Rationale: Postoperative nursing care for an infant with hydrocephalus who underwent ventriculoperitoneal shunt placement includes monitoring closely for signs of infection, as infection is the greatest hazard in the postoperative period. Signs of cerebrospinal fluid infection to watch for include elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity. The child should be placed with the operative side of the head up to reduce pressure on the valve. The shunt reservoir should not be pumped to maintain patency, as this can disrupt its function. Maintaining a Trendelenburg position to decrease pressure on the shunt is contraindicated as it can lead to increased intracranial pressure and compromise the shunt's effectiveness.

2. A 6-year-old child has patient-controlled analgesia (PCA) for pain management after orthopedic surgery. The parents are worried that their child will be in pain. What should your explanation to the parents include?

• A. The child will continue to sleep and be pain-free
• B. Parents cannot administer additional medication with the button
• C. The pump can deliver baseline and bolus dosages
• D. There is a high risk of overdose, so monitoring is done every 15 minutes

Correct answer: C

Rationale: PCA pumps are designed to deliver both a continuous baseline dose and patient-activated bolus doses, which can help manage pain effectively while minimizing the risk of overdose.

3. What statement best describes Hirschsprung disease?

• A. The colon has an aganglionic segment.
• B. It results in frequent evacuation of solids, liquid, and gas.
• C. The neonate passes excessive amounts of meconium.
• D. It results in excessive peristaltic movements within the gastrointestinal tract.

Correct answer: A

Rationale: Hirschsprung disease is characterized by the absence of ganglion cells in a segment of the colon, leading to a lack of peristalsis and obstruction. The other options do not accurately describe this condition.

4. Which parental statement indicates correct understanding of information presented regarding the prevention of iron deficiency anemia in infants?

• A. "We will add green leafy vegetables to our child’s low-iron formula."
• B. "We will discontinue the use of vitamin C supplements by 6 months of age."
• C. "We will begin an iron-fortified infant cereal at 4 to 6 months of age."
• D. "We will introduce cow’s milk by 6 months of age."

Correct answer: C

Rationale: The correct answer is C. Introducing iron-fortified cereal between 4 to 6 months of age is a recommended practice to prevent iron deficiency anemia in infants. Iron-fortified infant cereals are a good source of iron for infants. Choices A and B are incorrect because adding green leafy vegetables to low-iron formula and discontinuing vitamin C supplements do not directly address the prevention of iron deficiency anemia. Choice D is incorrect because cow's milk should be avoided before 12 months of age as it is low in iron and can lead to intestinal blood loss, increasing the risk of iron deficiency anemia.

5. A 12-year-old child is injured in a bicycle accident. When considering the possibility of renal trauma, the nurse should consider what factor?

• A. Flank pain rarely occurs in children with renal injuries.
• B. Few nonpenetrating injuries cause renal trauma in children.
• C. Kidneys are immobile, well protected, and rarely injured in children.
• D. The amount of hematuria is not a reliable indicator of the seriousness of renal injury.

Correct answer: D

Rationale: The amount of hematuria is not a reliable indicator of the severity of renal trauma, as even minor injuries can cause significant bleeding, while severe injuries may result in little or no visible blood. Renal trauma should be evaluated through imaging and clinical assessment.

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