Nursing Elites

1. The provider is educating the parents of a newborn about circumcision care. Which of the following instructions should be included?

• A. Cleanse the penis with each diaper change using alcohol wipes.
• B. Avoid using petroleum jelly on the circumcision site.
• C. Report any yellowish exudate around the head of the penis.
• D. Use warm water to clean the penis gently during diaper changes.

Correct answer: D

Rationale: The correct instruction for circumcision care is to use warm water to gently clean the penis during diaper changes. Alcohol wipes should be avoided as they can cause irritation. Yellowish exudate around the head of the penis is a normal part of the healing process and does not require reporting unless accompanied by other concerning symptoms. Avoiding petroleum jelly on the circumcision site is important to prevent trapping moisture and bacteria, which can lead to infection.

2. A child with type 1 diabetes mellitus is brought to the emergency department by the mother, who states that the child has been complaining of abdominal pain and has been lethargic. Diabetic ketoacidosis is diagnosed. Anticipating the plan of care, the nurse prepares to administer which type of intravenous (IV) infusion?

• A. 5% dextrose infusion
• B. Normal saline infusion
• C. NPH insulin infusion
• D. Potassium infusion

Correct answer: B

Rationale: In the management of diabetic ketoacidosis (DKA), the initial intravenous (IV) fluid of choice is normal saline infusion. Normal saline helps to correct dehydration and electrolyte imbalances commonly seen in DKA patients. It does not contain glucose to prevent worsening hyperglycemia or ketoacidosis. NPH insulin infusion is not the initial treatment for DKA; it is typically used after fluid resuscitation. Potassium infusion may be required in DKA to address electrolyte imbalances, but normal saline is the priority for fluid resuscitation.

3. A mother reported to you that her 6-year-old child is suffering from diarrhea. Which of the following advice will you give to the mother?

• A. Breastfeeding should be continued day and night
• B. Formula milk should be stopped for 6 hours
• C. Breast milk can be given together with oral rehydration salts
• D. A and C

Correct answer: D

Rationale: When a child is suffering from diarrhea, it is essential to continue breastfeeding day and night to maintain hydration and provide necessary nutrients. Stopping formula milk for 6 hours (choice B) is not the recommended approach as it may lead to a lack of essential nutrients during this critical time. Giving breast milk together with oral rehydration salts (choice C) can help replenish lost fluids and electrolytes, making it a suitable recommendation. Therefore, advising the mother to follow both options A and C is the most appropriate approach to manage the child's condition effectively.

4. How should you assist with the delivery of the baby's head?

• A. Grasping each side of the baby's head and gently pulling to facilitate delivery.
• B. Placing your fingers on the bony part of the skull and applying gentle pressure.
• C. Carefully rotating the baby's head to face up during delivery.
• D. Placing the palm of your hand firmly against the back of the baby's skull.

Correct answer: B

Rationale: To assist with the delivery of the baby's head, the correct technique involves placing your fingers on the bony part of the skull and applying gentle pressure. This method helps guide the baby's head through the birth canal safely and effectively. Choices A, C, and D are incorrect. Grasping and pulling the baby's head, rotating the head, or placing the palm of your hand against the back of the baby's skull can potentially cause harm or complications during delivery.

5. What comment made by a parent of a 1-month-old would alert the nurse about the presence of a congenital heart defect?

• A. He is always hungry.
• B. He tires out during feedings.
• C. He is fussy for several hours every day.
• D. He sleeps all the time.

Correct answer: B

Rationale: Observing a 1-month-old tiring out during feedings should alert the nurse to the possibility of a congenital heart defect. This symptom may indicate that the infant is expending excess energy to compensate for a heart issue, leading to fatigue during feeding. Choices A, C, and D do not directly relate to a congenital heart defect. Being always hungry, fussy, or sleeping a lot are not specific signs of a congenital heart defect in a 1-month-old.

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