Nursing Elites

1. The nurse observes that a newborn is having problems after birth. What should indicate a tracheoesophageal fistula?

• A. Jitteriness
• B. Meconium ileus
• C. Excessive frothy saliva
• D. Increased need for sleep

Correct answer: C

Rationale: Excessive frothy saliva is a hallmark sign of tracheoesophageal fistula. The abnormal connection between the esophagus and trachea causes difficulty in swallowing, leading to an accumulation of saliva in the mouth. This symptom is crucial for early identification and management of tracheoesophageal fistula. Choices A, B, and D are incorrect as they are not specific indicators of tracheoesophageal fistula.

2. At what age is it safe to give infants whole milk instead of commercial infant formula?

• A. 6 months
• B. 9 months
• C. 12 months
• D. 18 months

Correct answer: C

Rationale: Whole milk should not be introduced before 12 months because it lacks the necessary nutrients, such as iron, that infants need for proper growth and development.

3. What findings on physical assessment of a neonate would indicate the need for further evaluation?

• A. Nystagmus
• B. Epstein pearls
• C. Low-set ears
• D. Positive Babinski reflex

Correct answer: C

Rationale: Low-set ears in a neonate suggest major abnormalities and should prompt further evaluation. The correct alignment of the top of the pinnae of the ear with the outer canthus of the eye is crucial. Nystagmus, an involuntary eye movement, is common in newborns and often resolves on its own. Epstein pearls, small cysts on the hard palate, are insignificant and disappear over time. A positive Babinski reflex is normal in infants up to 1 year of age. Therefore, the presence of low-set ears is the most concerning finding that requires immediate attention.

4. A child is hospitalized in acute renal failure and has a serum potassium greater than 7 mEq/L. What temporary measures that will produce a rapid but transient effect to reduce the potassium should the nurse expect to be prescribed? (Select all that apply.)

• A. Dialysis
• B. All below
• C. Sodium bicarbonate
• D. Glucose 50% and insulin

Correct answer: A

Rationale: Calcium gluconate, sodium bicarbonate, and glucose with insulin are used as temporary measures to rapidly reduce serum potassium levels. They help shift potassium into cells and stabilize the heart but do not remove potassium from the body like dialysis does.

5. An important intervention for infants with developmental disabilities is to:

• A. Help parents realize their child will not develop further
• B. Stress the importance of early infant stimulation and intervention programs
• C. Have them institutionalized as soon as possible
• D. Have children reevaluated at 2 years of age to confirm the diagnosis

Correct answer: B

Rationale: The correct answer is B: Stress the importance of early infant stimulation and intervention programs. Early intervention programs are essential for infants with developmental disabilities as they can significantly impact the child's development and future outcomes. These programs provide necessary support and therapies to enhance the child's skills and abilities. Choice A is incorrect because it is crucial to provide hope and support to parents, emphasizing the potential for development and progress. Choice C is inappropriate and unethical as the first line of intervention. Institutionalization should only be considered in extreme cases where other options have been exhausted. Choice D is not the most crucial intervention at this stage. While reevaluation may be necessary, early intervention and support should be prioritized to maximize the child's developmental potential.

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