Nursing Elites

1. The nurse is teaching a parent of a 6-month-old infant with gastroesophageal reflux (GER) before discharge. What instructions should the nurse include?

• A. Elevate the head of the bed in the crib to a 90-degree angle while the infant is sleeping.
• B. Hold the infant in the prone position after a feeding.
• C. Discontinue breastfeeding so that a formula and rice cereal mixture can be used.
• D. Prescribed cimetidine (Tagamet) should be given 30 minutes before feedings.

Correct answer: D

Rationale: Cimetidine is an H2 blocker that reduces stomach acid, helping manage GER. Holding the infant in the prone position is not recommended due to the risk of SIDS. Breastfeeding should not be discontinued unless advised by a physician. Elevating the head to 90 degrees is excessive.

2. What is the primary symptom of congenital diaphragmatic hernia in a newborn?

• A. Cyanosis
• B. Bradycardia
• C. Absent breath sounds
• D. Tachypnea

Correct answer: C

Rationale: Absent breath sounds on the affected side are a primary symptom of congenital diaphragmatic hernia. Cyanosis, bradycardia, and tachypnea may also be present but are not the primary symptom. Cyanosis is a bluish discoloration of the skin due to poor oxygenation, bradycardia is a slower than normal heart rate, and tachypnea is rapid breathing.

3. Which pediatric disorder is associated with a 'boot-shaped' heart on a chest x-ray?

• A. Tetralogy of Fallot
• B. Transposition of the great arteries
• C. Coarctation of the aorta
• D. Ventricular septal defect

Correct answer: A

Rationale: The correct answer is A: Tetralogy of Fallot. Tetralogy of Fallot is often associated with a 'boot-shaped' heart appearance on a chest x-ray due to the characteristic heart anatomy in this condition. This appearance is caused by the combination of pulmonary stenosis, overriding aorta, ventricular septal defect, and right ventricular hypertrophy. Choice B, Transposition of the great arteries, is incorrect because it presents with a 'egg-on-a-string' appearance on x-ray due to the abnormal position of the aorta and pulmonary artery. Choice C, Coarctation of the aorta, typically presents with rib notching on x-ray. Choice D, Ventricular septal defect, does not produce the 'boot-shaped' heart appearance seen in Tetralogy of Fallot.

4. When auscultating an infant's lungs, the nurse detects diminished breath sounds. What should the nurse interpret this as?

• A. Suggestive of chronic pulmonary disease
• B. Suggestive of impending respiratory failure
• C. An abnormal finding warranting investigation
• D. A normal finding in infants younger than 1 year of age

Correct answer: C

Rationale: Diminished breath sounds in an infant are an abnormal finding and warrant further investigation to rule out conditions like atelectasis or pneumonia.

5. The nurse is caring for a very low-birth-weight (VLBW) infant with a peripheral intravenous infusion. What nursing considerations regarding infiltration should be included in planning IV care?

• A. Infiltration is not solely related to the activity level of VLBW infants.
• B. Continuous infusion pumps do not always stop automatically when infiltration occurs.
• C. Hypertonic solutions can cause severe tissue damage if infiltration occurs.
• D. The infusion site should be checked regularly to prevent infiltration-related complications.

Correct answer: C

Rationale: Hypertonic solutions can damage tissues if they leak from the vein due to infiltration. It is crucial to monitor for this complication to prevent severe tissue damage. Infiltration is not solely related to the activity level of VLBW infants; it can occur due to various reasons such as vein condition, catheter placement, and fluid type. Continuous infusion pumps may not always detect infiltration, as they typically alarm for pressure changes but not all infiltration instances. Checking the infusion site regularly, preferably hourly, is essential to prevent complications like tissue damage from extravasations, fluid overload, and dehydration.

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