Nursing Elites

1. When is cleft palate repair usually performed in children?

• A. A cleft palate cannot be repaired in children.
• B. Repair is usually performed by age 8 weeks.
• C. Repair is usually performed by 2 months of age.
• D. Repair is usually performed between 6 months and 2 years.

Correct answer: D

Rationale: Cleft palate repair timing is individualized based on the severity of the deformity and the child's size. Typically, cleft palate repair is performed between 6 months and 2 years of age. This age range allows for optimal outcomes and is often done before 12 months to promote normal speech development. Early closure of the cleft palate helps to facilitate speech development. Options A, B, and C are incorrect because a cleft palate can be repaired in children, and repair is usually performed between 6 months and 2 years of age, not at 8 weeks or 2 months.

2. A 3-year-old had a hip spica cast applied 2 hours ago. In order to facilitate drying, the nurse should

• A. Expose the cast to air and turn the child frequently
• B. Use a heat lamp to reduce the drying time
• C. Handle the cast with the abductor bar
• D. Turn the child as little as possible

Correct answer: A

Rationale: After applying a hip spica cast, it is important to facilitate drying by exposing the cast to air and turning the child frequently. This helps promote even drying and prevents complications such as skin breakdown. Using a heat lamp can cause burns and is not recommended. Handling the cast with the abductor bar does not aid in drying the cast. Turning the child as little as possible is incorrect as regular turning is crucial to prevent complications.

3. The client is seven (7) days post total hip replacement. Which statement by the client requires the nurse's immediate attention?

• A. I have bad muscle spasms in my lower leg of the affected extremity.
• B. I just can't 'catch my breath' over the past few minutes and I think I am in grave danger.
• C. I have to use the bedpan to pass my water at least every 1 to 2 hours.
• D. It seems that the pain medication is not working as well today.

Correct answer: B

Rationale: While all statements by the client require attention, the most critical one that demands immediate action is option B. Clients who have undergone hip or knee surgery are at an increased risk of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are hallmark signs of this condition. Without appropriate prophylaxis such as anticoagulant therapy, deep vein thrombosis (DVT) can develop within 7 to 14 days after surgery, potentially leading to pulmonary embolism. It is crucial for the nurse to recognize signs of DVT, which include pain, tenderness, skin discoloration, swelling, or tightness in the affected leg. Signs of pulmonary embolism include sudden onset dyspnea, tachycardia, confusion, and pleuritic chest pain. Option B indicates a potentially life-threatening situation that requires immediate intervention to prevent serious complications.

4. While eating in the hospital cafeteria, a nurse notices a toddler at a nearby table choking on a piece of food and appearing slightly blue. What is the appropriate initial action to take?

• A. Begin mouth-to-mouth resuscitation
• B. Give the child water to help with swallowing
• C. Perform 5 abdominal thrusts
• D. Call for the emergency response team

Correct answer: C

Rationale: When a toddler is choking on a piece of food and appears blue, it indicates airway obstruction. The appropriate initial action should be to perform 5 abdominal thrusts. This technique can help dislodge the obstructing object and clear the airway. Initiating mouth-to-mouth resuscitation is not recommended as the first step in a choking emergency, especially in children. Giving water may not be effective and can worsen the situation by causing further blockage. Calling the emergency response team should be considered if the abdominal thrusts are unsuccessful in clearing the airway.

5. During shift change, a healthcare professional is reviewing a patient's medication. Which of the following medications would be contraindicated if the patient were pregnant?

• A. Warfarin (Coumadin)
• B. Celecoxib (Celebrex)
• C. Clonidine (Catapres)
• D. Transdermal nicotine (Habitrol)

Correct answer: A

Rationale: Warfarin (Coumadin) is contraindicated in pregnancy due to its pregnancy category X classification. It is associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when administered at any time during pregnancy. Fetal warfarin syndrome can occur when given during the first trimester. Celecoxib (Celebrex) is a pregnancy category C medication, which means there may be risks but benefits may outweigh them. Clonidine (Catapres) is also a pregnancy category C drug, and while animal studies have shown adverse effects on the fetus, there are limited human studies. Transdermal nicotine (Habitrol) is classified as a pregnancy category D drug, indicating positive evidence of fetal risk, but benefits may still warrant its use in pregnant women with serious conditions.

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