Nursing Elites

1. When assessing a newborn for jaundice, which area should be examined?

• A. Legs and feet
• B. Chest and abdomen
• C. Face and sclera
• D. Back and buttocks

Correct answer: C

Rationale: When assessing a newborn for jaundice, the healthcare provider should examine the face and sclera. Jaundice is often first noticeable in these areas due to the buildup of bilirubin, causing a yellowish discoloration of the skin and eyes. Examining the legs and feet (Choice A) is not the most appropriate area for identifying jaundice in newborns. Similarly, the chest and abdomen (Choice B) are not the primary areas where jaundice is usually observed. Checking the back and buttocks (Choice D) is also not as useful as examining the face and sclera when assessing for jaundice in newborns.

2. 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.

3. When working with a new adolescent patient, which greeting by the nurse indicates awareness of the needs of the adolescent client?

• A. I will talk with your parents first, and then you can tell me why you are here.
• B. Please let me know what your concerns are, and if you have any questions.
• C. Before we begin, I will need to know if you are sexually active.
• D. I will do the physical exam first, and then we will talk about your history.

Correct answer: B

Rationale: The greeting 'Please let me know what your concerns are, and if you have any questions.' indicates awareness of the needs of the adolescent client. It encourages open communication, allows the adolescent to voice their concerns, and shows that their questions are welcomed and valued, fostering a trusting nurse-patient relationship. Choices A, C, and D do not prioritize the adolescent's perspective or promote open communication. Asking to talk to the parents first (Choice A) may hinder the adolescent's autonomy and trust. Inquiring about sexual activity (Choice C) may be necessary but should be approached with sensitivity and privacy. Doing the physical exam first (Choice D) before discussing the patient's history may not align with the adolescent's need for communication and understanding.

4. A 9-year-old girl was struck by a car while crossing the street. Your assessment reveals a large contusion over the left upper quadrant of her abdomen and signs of shock. Which of the following organs is MOST likely injured?

• A. Liver
• B. Kidney
• C. Pancreas
• D. Spleen

Correct answer: D

Rationale: The presence of a large contusion over the left upper quadrant of the abdomen, along with signs of shock, points towards a likely injury to the spleen, especially following trauma. The spleen is located in the left upper quadrant of the abdomen and is susceptible to injury due to its position and vulnerability to blunt trauma.

5. In growing children, growth hormone deficiency results in short stature and very slow growth rates. Short stature may result from which of the following?

• A. Anterior pituitary gland hypofunction
• B. Posterior pituitary gland hyperfunction
• C. Parathyroid gland hyperfunction
• D. Thyroid gland hyperfunction

Correct answer: A

Rationale: Short stature in growing children can result from anterior pituitary gland hypofunction, which leads to growth hormone deficiency. The anterior pituitary gland plays a crucial role in stimulating the release of growth hormone, and when it is underactive (hypofunction), insufficient growth hormone is produced, resulting in short stature and slow growth rates.

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