Nursing Elites

1. Marge is a 2-year-old girl who does not sit and eat at mealtimes but rather brings food to many rooms, eats a few bites, and drops it. Her parents report that she is a 'fussy eater.' Marge is significantly below weight for her age. She does not have any oral motor structure abnormalities, but eats only certain foods with the same texture. Which intervention strategy would be best to address the environmental context?

• A. Prolong mealtimes and eliminate all snacks
• B. Provide high-calorie snacks and meals at the table throughout the day
• C. Allow Marge to eat whenever and wherever she wants in the house
• D. Require Marge to eat everything on her plate and at snack

Correct answer: B

Rationale: In the case of Marge, who exhibits selective eating habits and struggles with weight gain, providing high-calorie snacks and meals at the table throughout the day can be an effective intervention. This strategy can help increase her food intake in a structured environment, promoting healthier eating habits and potentially addressing her below-average weight status. Choice A, prolonging mealtimes and eliminating all snacks, may not be the best approach as it could lead to more food refusal and stress during meals. Choice C, allowing Marge to eat whenever and wherever she wants in the house, may further enable her selective eating behavior and hinder progress. Choice D, requiring Marge to eat everything on her plate and at snack, can create a negative mealtime environment and may not address the underlying causes of her eating habits. Therefore, providing high-calorie snacks and meals at designated times offers a balanced approach to support Marge's nutritional needs and overall well-being.

2. A parent of an infant with gastroesophageal reflux is being taught by a nurse. Which of the following instructions should the nurse include in the teaching?

• A. Offer the infant feedings every 2 hours.
• B. Position the infant upright after feedings.
• C. Feed the infant thickened formula.
• D. Place the infant in a prone position after feedings.

Correct answer: B

Rationale: Correct posture after feedings is crucial for an infant with gastroesophageal reflux to reduce the risk of regurgitation. Placing the infant upright helps prevent the backflow of stomach contents into the esophagus, minimizing symptoms of reflux.

3. A newborn's parents are being taught about ways to prevent sudden infant death syndrome (SIDS). Which of the following instructions should be included?

• A. Place the infant in a prone position to sleep.
• B. Allow the infant to sleep on a large pillow.
• C. Use a soft mattress in the infant's crib.
• D. Give the infant a pacifier at bedtime.

Correct answer: D

Rationale: The correct instruction to prevent SIDS is to give the infant a pacifier at bedtime. The use of a pacifier while the infant is sleeping is associated with a decreased risk of SIDS. Placing the infant on their back to sleep is recommended to prevent SIDS, not in a prone position (Choice A). Allowing the infant to sleep on a large pillow (Choice B) is dangerous and increases the risk of SIDS. Using a soft mattress in the infant's crib (Choice C) is also a risk factor for SIDS, so it should be avoided. Additionally, soft bedding or pillows should be avoided to reduce the risk of SIDS.

4. What is the corrected age of a child born at 30 weeks gestation on May 2, 2014, who is being tested on August 5, 2014?

• A. 3 months
• B. 2 weeks
• C. 2.6 months
• D. 4 weeks

Correct answer: B

Rationale: To calculate the corrected age of a premature child, you need to adjust for the weeks of prematurity. In this case, the child was born at 30 weeks gestation. From May 2, 2014, to August 5, 2014, is a span of 14 weeks. Subtracting the 30 weeks of gestation from the total time passed (14 weeks) gives the corrected age, which is 14 - 30 = -16 weeks. Since negative weeks are not relevant here, the corrected age is 0 weeks, which is equivalent to 2 weeks. Choice A is incorrect because 3 months is not the correct adjustment for the given scenario. Choice C is incorrect as it provides a fractional value for age, which is not practical in this context. Choice D is incorrect as 4 weeks does not account for the weeks of prematurity.

5. A patient is 1 hour postoperative following an open reduction internal fixation of the left tibia. Which of the following actions should the nurse take?

• A. Assess neurovascular status of the extremities every 4 hours
• B. Monitor the patient's pain level every 8 hours
• C. Assist the patient to the bathroom every 2 hours
• D. Keep the patient's left leg elevated on two pillows

Correct answer: A

Rationale: The correct action for the nurse to take 1 hour postoperative following an open reduction internal fixation of the left tibia is to assess neurovascular status of the extremities every 4 hours. This frequent assessment is crucial to monitor for any signs of complications such as impaired circulation or nerve damage. Monitoring every 4 hours allows for early detection of any issues, enabling timely intervention and prevention of potential complications. Monitoring the patient's pain level every 8 hours (choice B) is not as immediate or essential for postoperative care. Assisting the patient to the bathroom every 2 hours (choice C) may not be necessary if the patient is not ambulatory yet. Keeping the patient's left leg elevated on two pillows (choice D) can be beneficial but is not the priority in the immediate postoperative period compared to assessing neurovascular status.

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