Nursing Elites

1. The mother of an 11-year-old boy with juvenile arthritis tells the nurse, 'I really don’t want my son to become dependent on pain medication, so I only allow him to take it when he is really hurting.' Which information is most important for the nurse to provide this mother?

• A. Encouraging the child to rest when he experiences pain
• B. Encouraging quiet activities like watching television as a pain distractor
• C. Suggesting the use of hot baths as an alternative to pain medication
• D. Explaining that giving pain medication around the clock helps control the pain

Correct answer: D

Rationale: The nurse should educate the mother that giving pain medication around the clock helps maintain a consistent level of pain control, preventing severe pain episodes and improving the child's quality of life. It is essential to manage pain proactively rather than waiting for the child to be in severe pain before administering medication. Choices A, B, and C do not address the importance of proactive pain management and maintaining a consistent level of pain control. Encouraging rest, quiet activities, or hot baths as distractions or alternatives may not provide adequate pain relief for the child with juvenile arthritis, and they do not address the underlying issue of effective pain management.

2. After observing a mother giving her 11-month-old ferrous sulfate followed by two ounces of orange juice, what should the nurse do next?

• A. Suggest placing the iron drops in the orange juice and feed the infant.
• B. Advise the mother to follow the iron drops with formula instead of orange juice.
• C. Instruct the mother to feed the infant nothing in the next 30 minutes after the iron.
• D. Give positive feedback about the way she administered the sulfate.

Correct answer: D

Rationale: Providing positive feedback is essential in reinforcing correct behaviors. By praising the mother for properly administering the ferrous sulfate to her 11-month-old, the nurse can encourage her to continue following the correct procedure. This positive reinforcement can boost the mother's confidence and adherence to the recommended administration method, ultimately benefiting the infant's health.

3. The nurse is measuring the frontal occipital circumference (FOC) of a 3-month-old infant and notes that the FOC has increased by 5 inches since birth, and the child's head appears large in relation to body size. Which action is most important for the nurse to take next?

• A. Measure the infant's head-to-toe length.
• B. Palpate the anterior fontanel for tension and bulging.
• C. Observe the infant for sunken eyes.
• D. Plot the measurement on the infant's growth chart.

Correct answer: B

Rationale: Palpating the anterior fontanel for tension and bulging is crucial in assessing for increased intracranial pressure. In this scenario, the infant's large head size and rapid increase in the frontal occipital circumference raise concerns for potential issues such as hydrocephalus. Measuring the head-to-toe length (Choice A) is not the priority when assessing for increased intracranial pressure. Observing for sunken eyes (Choice C) is more indicative of dehydration rather than increased intracranial pressure. While plotting the measurement on the infant's growth chart (Choice D) is important for tracking growth, it does not address the immediate concern of assessing for increased intracranial pressure.

4. During a follow-up clinical visit, a mother tells the nurse that her 5-month-old son, who had surgical correction for tetralogy of Fallot, has rapid breathing, often takes a long time to eat, and requires frequent rest periods. The infant is not crying while being held, and his growth is in the expected range. Which intervention should the nurse implement?

• A. Stimulate the infant to cry to produce cyanosis
• B. Auscultate the heart and lungs while the infant is held
• C. Evaluate the infant for failure to thrive
• D. Obtain a 12-lead electrocardiogram

Correct answer: B

Rationale: Auscultating the heart and lungs while the infant is held can provide important diagnostic information in assessing the cardiac and respiratory status of the infant who had surgical correction for tetralogy of Fallot. This intervention can help the nurse identify any abnormal heart or lung sounds, which may indicate complications or issues that need further evaluation or intervention.

5. A mother brings her 3-month-old infant to the clinic, concerned about frequent vomiting after feeding. The practical nurse (PN) suspects gastroesophageal reflux (GER). Which recommendation should the PN provide to the mother?

• A. Feed the infant in a prone position.
• B. Provide larger, less frequent feedings.
• C. Keep the infant upright for 30 minutes after feeding.
• D. Offer only formula thickened with rice cereal.

Correct answer: C

Rationale: The correct recommendation for reducing symptoms of gastroesophageal reflux (GER) in infants is to keep the infant upright for 30 minutes after feeding. This position helps prevent the backflow of stomach contents, alleviating symptoms of reflux. Placing the infant in a prone position or providing larger, less frequent feedings may worsen symptoms by increasing the likelihood of regurgitation. Offering only formula thickened with rice cereal is not the first-line intervention for GER and should not be recommended initially.

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