Nursing Elites

1. The caregiver is caring for an infant with osteogenesis imperfecta and is providing instruction on how to reduce the risk of injury. Which response from the caregiver indicates a need for further teaching?

• A. I need to avoid pushing or pulling on an arm or leg.
• B. I should carefully lift the baby by supporting the head and neck.
• C. I should not bend an arm or leg into an awkward position.
• D. We must avoid lifting the legs by the ankles to change diapers.

Correct answer: B

Rationale: Lifting the baby by supporting the head and neck can cause fractures in infants with osteogenesis imperfecta. Caregivers should avoid lifting infants in this manner due to the risk of injury. Choices A, C, and D demonstrate correct understanding of how to prevent injuries in infants with osteogenesis imperfecta by avoiding excessive force on the arms or legs, preventing awkward positions, and lifting the legs in a safer manner to change diapers.

2. A newborn with an anorectal anomaly had an anoplasty performed. At the 2-week follow-up visit, a series of anal dilations are begun. What should the nurse recommend to the parents to help prevent the infant from becoming constipated?

• A. Use a soy formula.
• B. Breastfeed if possible.
• C. Administer a suppository nightly.
• D. Offer glucose water between feedings.

Correct answer: B

Rationale: Breastfeeding is the best recommendation to help prevent constipation in infants. Breast milk is easily digestible and contains the right balance of nutrients, which can lead to softer stools, thus reducing the likelihood of constipation. Offering a soy formula (Choice A) may not necessarily prevent constipation as effectively as breast milk due to differences in nutrient composition. Administering a suppository nightly (Choice C) is not a routine measure for preventing constipation in infants and may not be suitable for regular use in this scenario. Offering glucose water (Choice D) between feedings is not recommended as it does not provide the necessary nutrients found in breast milk, which are essential for preventing constipation and promoting overall health in newborns.

3. What are the most common signs and symptoms of leukemia related to bone marrow involvement?

• A. petechiae, infection, fatigue
• B. headache, papilledema, irritability
• C. muscle wasting, weight loss, fatigue
• D. decreased intracranial pressure, psychosis, confusion

Correct answer: A

Rationale: Petechiae, infection, and fatigue are common signs and symptoms of leukemia related to bone marrow involvement. Petechiae are small red or purple spots on the skin caused by bleeding under the skin due to low platelet counts. Infection susceptibility increases due to decreased white blood cells from compromised bone marrow function. Fatigue is a common symptom of anemia resulting from decreased red blood cell production. Choices B, C, and D are incorrect as they do not align with the typical signs and symptoms of leukemia associated with bone marrow dysfunction.

4. What are general guidelines when assessing a 2-year-old child with abdominal pain and adequate perfusion?

• A. Examining the child in the parent's arms
• B. Palpating the painful area of the abdomen first
• C. Placing the child supine and palpating the abdomen
• D. Separating the child from the parent to ensure a reliable examination

Correct answer: A

Rationale: When assessing a 2-year-old child with abdominal pain and adequate perfusion, it is important to examine the child in the parent's arms. This approach helps reduce the child's anxiety, provides comfort, and can facilitate a more accurate assessment. Palpating the painful area of the abdomen first (choice B) may cause discomfort and increase anxiety in the child. Placing the child supine and palpating the abdomen (choice C) without considering the child's comfort and security may lead to resistance and inaccurate assessment. Separating the child from the parent to ensure a reliable examination (choice D) can further increase anxiety and hinder the assessment process. Therefore, examining the child in the parent's arms (choice A) is the most appropriate and effective approach in this scenario.

5. A 3-year-old child ingests a substance that may be a poison. The parent calls a neighbor who is a nurse and asks what to do. What should the nurse recommend the parent to do?

• A. Administer syrup of ipecac.
• B. Call the poison control center.
• C. Take the child to the emergency department.
• D. Give the child bread dipped in milk to absorb the poison.

Correct answer: B

Rationale: In cases of potential poisoning, immediate guidance from professionals is crucial. Administering syrup of ipecac is no longer recommended routinely due to potential risks and lack of benefit. Taking the child to the emergency department is necessary in severe cases but may not always be the immediate action needed. Giving the child bread dipped in milk is not an appropriate method to manage poisoning and could potentially worsen the situation. Therefore, the most appropriate action for the nurse to recommend is to call the poison control center for expert advice on managing the situation.

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