Nursing Elites

1. What should you do immediately upon delivery of a newborn's head?

• A. Suction the nose.
• B. Dry the face.
• C. Cover the eyes.
• D. Suction the mouth.

Correct answer: D

Rationale: Upon delivery of a newborn's head, the priority is to clear the airway to ensure proper breathing. Suctioning the mouth takes precedence over suctioning the nose or other actions to prevent potential airway obstruction. Choice D is the correct answer as it addresses the immediate need to maintain a clear airway for the newborn. Choices A, B, and C are not the correct actions to take at this moment as they do not directly address the crucial need to establish a clear airway for the newborn.

2. Seizures in children MOST often result from:

• A. a life-threatening infection.
• B. an inflammatory process in the brain.
• C. an abrupt rise in body temperature.
• D. a temperature greater than 102°F.

Correct answer: C

Rationale: Seizures in children most often result from febrile seizures, which are triggered by an abrupt rise in body temperature. Febrile seizures are common in young children, especially between the ages of 6 months to 5 years, and are usually associated with viral infections that cause a sudden spike in body temperature. Choices A, B, and D are incorrect because while infections, inflammatory processes, and high temperatures can sometimes lead to seizures, the most common cause of seizures in children is an abrupt increase in body temperature, known as febrile seizures.

3. During the 5-minute Apgar assessment of a newborn, you note a heart rate of 130 beats/min, cyanosis in the hands and feet, and rapid respirations. The baby cries when you flick the soles of its feet and resists leg straightening. These findings correspond to an Apgar score of:

• A. 9
• B. 7
• C. 8
• D. 10

Correct answer: A

Rationale: The Apgar score is a rapid assessment tool to evaluate the newborn's transition to life outside the womb. The Apgar score is based on five components: heart rate (>100 bpm), respiratory effort (rapid breathing), muscle tone (resisting leg straightening), reflex irritability (crying when feet are flicked), and color (cyanosis to extremities). The described findings match a score of 9, indicating good overall condition and adaptation to extrauterine life.

4. A 3-year-old child has been admitted to your pediatric ward. The doctor gave a provisional diagnosis of respiratory tract infection. After careful assessment and history, a final diagnosis of lower respiratory infection was made. Which of the following signs will confirm the diagnosis?

• A. Cough
• B. Fever
• C. Inability to lie supine
• D. Inability to eat

Correct answer: C

Rationale: Inability to lie supine is a characteristic sign of lower respiratory infection. This positioning preference is often seen in patients with lower respiratory infections due to discomfort or difficulty breathing when lying flat on their back. While cough and fever are common symptoms associated with respiratory infections, they are not specific to lower respiratory infections. Inability to eat may indicate general illness or discomfort but is not a specific indicator of lower respiratory infection.

5. A 3-year-old female presents with respiratory distress. She is conscious, crying, and clinging to her mother. She has mild intercostal retractions and an oxygen saturation of 93%. The MOST effective way of delivering oxygen to her involves:

• A. gently restraining her and assisting with ventilations.
• B. ventilations with a flow-restricted, oxygen-powered device.
• C. a non-rebreathing mask with the flow rate set at 6 to 8 L/min.
• D. asking the mother to hold an oxygen mask near her face.

Correct answer: C

Rationale: In a pediatric patient with respiratory distress, a non-rebreathing mask with a flow rate set at 6 to 8 L/min is the most effective way to deliver oxygen. This method ensures a high concentration of oxygen is delivered to the child, aiding in improving oxygen saturation levels. In this scenario, the mother can assist in holding the mask to maintain comfort and cooperation in the child while ensuring proper oxygen delivery.

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