Nursing Elites

1. After surgery to correct hypertrophic pyloric stenosis (HPS) in a 3-week-old infant who had been formula-fed, which postoperative feeding order is appropriate?

• A. Thickened formula 24 hours after surgery
• B. Withholding feedings for the first 24 hours
• C. Regular formula feeding within 24 hours after surgery
• D. Additional glucose feedings as desired after the first 24 hours

Correct answer: C

Rationale: After surgery for hypertrophic pyloric stenosis (HPS), it is appropriate to resume regular formula feeding within 24 hours postoperatively to promote recovery. Choice A, thickened formula after surgery, may be too heavy for the infant's digestive system at this early stage. Withholding feedings for the first 24 hours (Choice B) is not recommended as early feeding helps with recovery. Additional glucose feedings (Choice D) are not necessary and may not provide the balanced nutrition required after surgery.

2. A 4-year-old child is admitted with a diagnosis of bacterial pneumonia. What is the priority nursing intervention?

• A. Administering antipyretics
• B. Administering antibiotics
• C. Monitoring fluid intake
• D. Providing nutritional support

Correct answer: B

Rationale: The priority nursing intervention in a 4-year-old child admitted with bacterial pneumonia is administering antibiotics. Antibiotics are crucial for treating the infection and preventing potential complications. Administering antipyretics (Choice A) may help reduce fever, but addressing the underlying infection with antibiotics is the priority. Monitoring fluid intake (Choice C) is important for hydration but does not take precedence over administering antibiotics. Providing nutritional support (Choice D) is essential for overall care but is not the immediate priority when managing bacterial pneumonia.

3. The nurse is assessing a child with a possible fracture. What would the nurse identify as the most reliable indicator?

• A. Lack of spontaneous movement
• B. Point tenderness
• C. Bruising
• D. Inability to bear weight

Correct answer: B

Rationale: Point tenderness is the most reliable indicator of a possible fracture in a child. It is a localized tenderness experienced when pressure is applied to a specific area, suggesting a potential fracture. This tenderness is considered more specific to a fracture than other symptoms such as lack of spontaneous movement, bruising, or inability to bear weight. Lack of spontaneous movement and inability to bear weight can be present in various musculoskeletal injuries, while bruising may not always be immediate or specific to a fracture.

4. During the second week of hospitalization for intravenous antibiotic therapy, a 2-year-old toddler whose family is unable to visit often smiles easily, goes to all the nurses happily, and does not express interest in the parent when the parent does visit. The parent tells the nurse, 'I am pleased about the adjustment but somewhat concerned about my child’s reaction to me.' How should the nurse respond?

• A. The child is repressing feelings towards the parent.
• B. Routines have been established, and the child feels safe.
• C. The child has given up fighting and accepts the separation.
• D. Behavior has improved because the child feels better physically.

Correct answer: C

Rationale: The correct answer is C. The child's behavior of smiling easily, interacting happily with nurses, and showing disinterest in the parent when they visit indicates that the child has emotionally withdrawn and accepted the separation. This response suggests that the child may have given up fighting against the separation from the parent due to prolonged hospitalization. Choices A, B, and D are incorrect. Choice A about the child repressing feelings towards the parent is not supported by the scenario. Choice B about routines and feeling safe does not address the emotional aspect of the child's behavior. Choice D about improved behavior due to feeling better physically does not explain the emotional dynamics at play in the child's behavior.

5. The nurse is implementing care for a school-age child admitted to the pediatric intensive care unit with diabetic ketoacidosis (DKA). Which prescribed intervention should the nurse implement first?

• A. Begin 0.9% saline solution intravenously as prescribed
• B. Administer regular insulin intravenously as prescribed
• C. Place the child on a cardiac monitor
• D. Place the child on a pulse oximetry monitor

Correct answer: A

Rationale: The correct first intervention when managing a child with diabetic ketoacidosis is to begin intravenous saline solution to address dehydration and restore electrolyte balance. Rehydration is essential to improve perfusion and correct electrolyte imbalances. Administering insulin without addressing dehydration can potentially lead to further complications. Placing the child on a cardiac monitor or pulse oximetry monitor is important but not the initial priority in managing DKA.

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