Nursing Elites

1. The nurse is taking a health history of an adolescent. Which best describes how the chief complaint should be determined?

• A. Request a detailed listing of symptoms.
• B. Ask the adolescent, "Why did you come here today?"
• C. Interview the parent away from the adolescent to determine the chief complaint
• D. Use what the adolescent says to determine, in correct medical terminology, what the problem is

Correct answer: B

Rationale: Asking the adolescent directly about the reason for their visit encourages open communication and helps the nurse understand the primary concern from the patient's perspective.

2. The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge?

• A. Surgery is recommended as soon as possible.
• B. The defect usually resolves spontaneously by 3 to 5 years of age.
• C. Aggressive treatment is necessary to reduce its high mortality.
• D. Taping the abdomen to flatten the protrusion is not recommended.

Correct answer: B

Rationale: The correct answer is B. Most umbilical hernias in newborns resolve on their own by 3 to 5 years of age without the need for surgical intervention, unless complications arise. Surgery is not typically recommended for umbilical hernias in newborns due to the high rate of spontaneous resolution. Aggressive treatment is not necessary as umbilical hernias are typically benign and not associated with high mortality. Taping the abdomen is not recommended as it can cause skin irritation and does not speed up the resolution of the hernia.

3. An infant with hydrocephalus is hospitalized for surgical placement of a ventriculoperitoneal shunt. Postoperative nursing care would include what?

• A. Monitor closely for signs of infection.
• B. Place the child with the operative side of the head up.
• C. Avoid pumping the shunt reservoir to maintain patency.
• D. Avoid maintaining a Trendelenburg position to decrease pressure on the shunt.

Correct answer: A

Rationale: Postoperative nursing care for an infant with hydrocephalus who underwent ventriculoperitoneal shunt placement includes monitoring closely for signs of infection, as infection is the greatest hazard in the postoperative period. Signs of cerebrospinal fluid infection to watch for include elevated temperature, poor feeding, vomiting, decreased responsiveness, and seizure activity. The child should be placed with the operative side of the head up to reduce pressure on the valve. The shunt reservoir should not be pumped to maintain patency, as this can disrupt its function. Maintaining a Trendelenburg position to decrease pressure on the shunt is contraindicated as it can lead to increased intracranial pressure and compromise the shunt's effectiveness.

4. A two-month-old infant who has gastroesophageal reflux is thriving without other complications. Which instruction should the nurse include in the teaching plan?

• A. Place the infant in the Trendelenburg position after feeding
• B. Thicken formula with rice cereal
• C. Give continuous nasogastric feedings
• D. Give larger, less frequent feeds

Correct answer: B

Rationale: The correct instruction for a two-month-old infant with gastroesophageal reflux who is thriving without complications is to thicken the formula with rice cereal. This can help reduce reflux by increasing the weight of the formula, making it less likely to be regurgitated. Placing the infant in the Trendelenburg position after feeding (Choice A) is not recommended as it can increase the risk of aspiration. Continuous nasogastric feedings (Choice C) are not typically indicated for uncomplicated reflux in infants. Giving larger, less frequent feeds (Choice D) can worsen reflux symptoms by overloading the stomach.

5. The nurse is reviewing the Healthy People 2020 leading health indicators for a child health promotion program. Which are included in the leading health indicators? (Select all that apply.)

• A. Decrease tobacco use
• B. Improve immunization rates
• C. All are applicable
• D. Increase access to health care

Correct answer: C

Rationale: Healthy People 2020 focuses on decreasing tobacco use, improving immunization rates, and increasing access to healthcare among its leading health indicators.

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