Nursing Elites

1. The nurse is assessing a 3-year-old African American child whose height and weight are at the 20th percentile on the growth chart. What should the nurse recognize?

• A. The data suggest the child requires nutritional intervention
• B. The NCHS charts are accurate for U.S. African American children
• C. A correction factor is used for nonwhite ethnic groups
• D. No assessment can be made until several measurements are plotted over time

Correct answer: B

Rationale: The NCHS growth charts serve as reference guides for all racial or ethnic groups, including African American children. The 20th percentile for height and weight does not indicate nutritional failure but provides a reference point for ongoing assessment. Choice A is incorrect because being at the 20th percentile does not automatically imply the need for nutritional intervention. Choice C is incorrect as there is no correction factor specifically used for nonwhite ethnic groups in this context. Choice D is incorrect as a single measurement at the 20th percentile can provide valuable information for assessment.

2. A parent of an infant with gastroesophageal reflux asks how to decrease the number and total volume of emesis. What recommendation should the nurse include in teaching this parent?

• A. Surgical therapy is indicated.
• B. Place the infant in a prone position for sleep after feeding.
• C. Thicken feedings and enlarge the nipple hole.
• D. Reduce the frequency of feeding by encouraging larger volumes of formula.

Correct answer: C

Rationale: The correct recommendation for decreasing the number and total volume of emesis in an infant with gastroesophageal reflux is to thicken feedings and enlarge the nipple hole. Thicker feedings can reduce the frequency and volume of emesis by making the food less likely to be regurgitated. Enlarging the nipple hole helps ensure the thickened feedings can pass through. Surgical therapy (Choice A) is not the initial recommendation for managing gastroesophageal reflux in infants. Placing the infant in a prone position for sleep after feeding (Choice B) is not recommended due to the increased risk of sudden infant death syndrome (SIDS). Reducing the frequency of feeding by encouraging larger volumes of formula (Choice D) can exacerbate the reflux symptoms.

3. Which immunization should the nurse include in a teaching session for parents of toddler-age clients to decrease the risk for epiglottitis?

• A. Hepatitis B
• B. Polio
• C. Measles, mumps, and rubella (MMR)
• D. Hemophilus influenzae type B (Hib)

Correct answer: D

Rationale: The correct answer is D, Hemophilus influenzae type B (Hib) vaccine. Hib vaccine is crucial in preventing epiglottitis, a serious respiratory condition caused by Haemophilus influenzae type b bacteria. This vaccine is recommended for toddlers to protect them from developing epiglottitis. Choices A, B, and C are incorrect because while they are important vaccines for children, they do not specifically target the prevention of epiglottitis, unlike the Hib vaccine.

4. What is the appropriate site to administer an intramuscular (IM) vaccine to a newborn?

• A. The dorsal gluteal muscle
• B. The vastus lateralis muscle
• C. The ventral gluteal muscle
• D. The biceps muscle

Correct answer: B

Rationale: The correct site to administer an intramuscular (IM) vaccine to a newborn is the vastus lateralis muscle. For newborns, the vastus lateralis is preferred over the dorsogluteal site because the dorsogluteal site has been associated with low antibody seroconversion rates, indicating a reduced immune response. The vastus lateralis is also recommended for IM injections in newborns, while the deltoid muscle is preferred for older infants and children. The ventral gluteal muscle and the biceps muscle are not appropriate sites for IM injections. Therefore, choice B is the correct answer.

5. A child has a central venous access device for intravenous (IV) fluid administration. A blood sample is needed for a complete blood count, hemogram, and electrolytes. What is the appropriate procedure to implement for this blood sample?

• A. Perform a new venipuncture to obtain the blood sample.
• B. Interrupt the IV fluid and withdraw the blood sample needed.
• C. Withdraw a blood sample equal to the amount of fluid in the device, discard, and then withdraw the sample needed.
• D. Flush the line and central venous device with saline and then aspirate the required amount of blood for the sample.

Correct answer: C

Rationale: Withdrawing and discarding a sample equal to the amount of fluid in the device ensures that the blood drawn is not diluted by the IV fluids, providing accurate lab results.

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