Nursing Elites

1. The nurse is unsuccessful in inserting a nasogastric tube for a newborn client. The nurse suspects the newborn has esophageal atresia/tracheoesophageal (EA/TE) fistula. Which nursing action is appropriate while waiting for the healthcare provider to further assess the neonate?

• A. Position the newborn in a semi-Fowler position.
• B. Allow the newborn to stay in the nursery for observation.
• C. Offer the newborn pacifier for comfort.
• D. Wrap the newborn in blankets and place in an incubator.

Correct answer: A

Rationale: Positioning the newborn in a semi-Fowler position is appropriate as it helps prevent aspiration in suspected EA/TE fistula. This position helps reduce the risk of regurgitation and aspiration of gastric contents. Placing the newborn in a semi-Fowler position promotes the drainage of secretions and reduces the risk of complications while awaiting further assessment by the healthcare provider.

2. The healthcare provider is assessing abdominal girth for a pediatric client who presents with abdominal distension. Which nursing action is appropriate?

• A. Measuring the girth just below the umbilicus
• B. Measuring the girth just below the sternum
• C. Measuring the girth just above the pubic bone
• D. Measuring the girth around the largest portion of the abdomen

Correct answer: D

Rationale: Measuring the girth around the largest portion of the abdomen ensures accurate assessment and tracking of abdominal distension. This method provides a more comprehensive measurement and helps healthcare providers monitor changes effectively.

3. When receiving change-of-shift report for children, which child should the nurse assess first?

• A. A toddler who has a concussion and an episode of forceful vomiting
• B. An adolescent with infective endocarditis who reports having a headache
• C. An adolescent who was placed into Halo traction 1 hour ago and rates his pain at a 6 on a 0-10 scale
• D. A school-age child with acute glomerulonephritis and brown-colored urine

Correct answer: A

Rationale: The nurse should assess the toddler with a concussion and an episode of forceful vomiting first when receiving change-of-shift report for children. Forceful vomiting in a toddler with a concussion indicates increased intracranial pressure, requiring immediate assessment and intervention to prevent further complications.

4. How should professionals communicate with parents and family members?

• A. Share information with both parents to distribute the stress equally
• B. Share information with one parent to ensure accuracy
• C. Share information with all individuals who interact with the child, whether family or not
• D. Provide information in writing exclusively to ensure clear communication

Correct answer: C

Rationale: When professionals communicate with parents and family members, it is essential to share information with all individuals who interact with the child, whether they are family members or not. This inclusive approach ensures that everyone involved in the child's care and well-being is well-informed and can provide support as needed. It is important to consider the broader network of individuals who play a role in the child's life to promote comprehensive and effective communication.

5. A nurse is providing discharge teaching to the parent of a school-age child who has moderate persistent asthma. Which of the following instructions should the nurse include?

• A. You should give your child his salmeterol inhaler every 4 hours when he is having an acute episode of wheezing.
• B. You should monitor your child's weight weekly while he is receiving inhaled corticosteroid therapy.
• C. Pulmonary function tests will be performed every 12 to 24 months to evaluate how your child is responding to therapy.
• D. When using the peak expiratory flow meter, record your child's average of three readings.

Correct answer: C

Rationale: The nurse should inform the parent that the child will need pulmonary function tests every 12 to 24 months to assess lung function and response to treatment. These tests help evaluate the presence of lung disease, monitor disease progression, and assess the effectiveness of the current therapeutic regimen in managing asthma. Choice A is incorrect as salmeterol is not used for acute wheezing episodes but rather for long-term maintenance. Choice B is incorrect because weight monitoring is not directly related to inhaled corticosteroid therapy for asthma. Choice D is incorrect as peak expiratory flow meter readings should be recorded as instructed, not averaged.

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