Nursing Elites

1. The healthcare provider is assessing an infant and notes that the infant's urine has a mousy or musty odor. What would the healthcare provider suspect?

• A. Maple syrup urine disease
• B. Tyrosinemia
• C. Phenylketonuria
• D. Trimethylaminuria

Correct answer: C

Rationale: Phenylketonuria (PKU) is suggested by a mousy or musty odor of the urine, caused by the inability to metabolize phenylalanine. Maple syrup urine disease (Choice A) is characterized by a sweet-smelling urine. Tyrosinemia (Choice B) presents with cabbage-like odor in the urine. Trimethylaminuria (Choice D) results in a fishy odor in the urine, breath, and sweat.

2. The nurse is caring for a child and family who just moved out of a dangerous neighborhood. Which of the following approaches is appropriate based on the family stress theory?

• A. Determining who the decision-maker is
• B. Assessing the child's coping abilities
• C. Exploring how a sibling feels
• D. Explaining procedures to a sibling

Correct answer: B

Rationale: Assessing the child's coping abilities is appropriate based on the family stress theory because it helps the nurse understand how well the child can manage and adapt to the stressors related to the move. This assessment can guide interventions to support the child's emotional well-being and adjustment. Choices A, C, and D are not directly related to assessing the child's coping abilities and may not address the child's immediate needs during this stressful time.

3. Why is the infant scheduled to receive the intramuscular polio vaccine instead of the oral vaccine, as asked by the parents?

• A. The American Academy of Pediatrics recommends the intramuscular vaccine because it is safer.
• B. Both vaccines produce the same results and are equally safe, according to consensus.
• C. The intramuscular vaccine is preferred over the oral vaccine due to cost considerations, unless contraindicated.
• D. The U.S. Centers for Disease Control and Prevention recommends the intramuscular vaccine unless the infant or a family member is immunocompromised.

Correct answer: A

Rationale: The American Academy of Pediatrics recommends the intramuscular polio vaccine over the oral vaccine due to its superior safety profile. Intramuscular administration ensures better immunogenicity and protection against poliovirus. Choice B is incorrect as the intramuscular vaccine is preferred for safety reasons. Choice C is incorrect because the recommendation is based on safety, not cost. Choice D is incorrect as the CDC recommendation is not solely based on immunocompromised status but rather on the overall safety and efficacy of the vaccine.

4. A 3-month-old infant has been hospitalized with respiratory syncytial virus (RSV). What is the priority intervention?

• A. Administering an antiviral agent
• B. Clustering care to conserve energy
• C. Offering oral fluids to promote hydration
• D. Providing an antitussive agent when necessary

Correct answer: B

Rationale: The priority intervention for a 3-month-old infant hospitalized with respiratory syncytial virus (RSV) is to cluster care to conserve energy. Infants with RSV often have difficulty breathing and need to rest frequently. Clustering care involves grouping nursing interventions to allow for longer periods of rest between activities, which helps prevent exhaustion and conserve the infant's energy. Administering an antiviral agent is not the primary intervention for RSV, as it is a viral infection and antiviral agents are not typically used for RSV. Offering oral fluids is important for hydration but may not be the priority when the infant is struggling to breathe. Providing an antitussive agent should be done judiciously and under medical guidance, as suppressing the cough reflex can be detrimental in RSV cases where coughing helps clear airway secretions.

5. A parent arrives in the emergency clinic with a 3-month-old baby who has difficulty breathing and prolonged periods of apnea. Which assessment data should alert the nurse to suspect shaken baby syndrome (SBS)?

• A. Birth occurred before 32 weeks’ gestation
• B. Lack of stridor and adventitious breath sounds
• C. Previous episodes of apnea lasting 10 to 15 seconds
• D. Retractions and use of accessory respiratory muscles

Correct answer: D

Rationale: Retractions and the use of accessory respiratory muscles are signs of respiratory distress in infants. These clinical manifestations can be associated with trauma, such as shaken baby syndrome (SBS), which can lead to severe head injuries and respiratory compromise. Birth before 32 weeks’ gestation (Choice A) is more related to prematurity complications rather than SBS. The absence of stridor and adventitious breath sounds (Choice B) may not be specific indicators of SBS. Previous episodes of apnea lasting 10 to 15 seconds (Choice C) alone may not be as concerning as the presence of retractions and use of accessory muscles in the context of a distressed infant.

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