Nursing Elites

1. When should the surgical correction of hypospadias in a newborn infant typically be done?

• A. Repair should be done by one month to prevent bladder infection.
• B. To form a proper urethra repair, it should be done after sexual maturity.
• C. Repairs typically should be done before the child is potty trained.
• D. Delaying the repair until school age reduces castration fears.

Correct answer: C

Rationale: Surgical repairs for hypospadias are typically recommended to be performed before the child is potty trained. This timing helps in avoiding complications, ensures better outcomes, and makes the surgical process smoother. Early correction also minimizes the psychological impact on the child regarding genital differences and can improve long-term psychological well-being. Choices A, B, and D are incorrect because repairing hypospadias at one month to prevent bladder infection, after sexual maturity to form a proper urethra, or delaying the repair until school age to reduce castration fears are not the standard recommendations. The optimal timing for surgical correction is before the child is potty trained to achieve the best results and psychological outcomes.

2. A school-age child with a history of type 1 diabetes mellitus is brought to the emergency department with confusion and rapid breathing. The practical nurse (PN) suspects diabetic ketoacidosis (DKA). Which initial intervention should the PN anticipate?

• A. Administer subcutaneous insulin.
• B. Give oral glucose tablets.
• C. Start intravenous fluids.
• D. Administer oxygen therapy.

Correct answer: C

Rationale: Intravenous fluids are typically the initial intervention in diabetic ketoacidosis (DKA) to treat dehydration and stabilize the patient's condition. The fluid replacement helps correct electrolyte imbalances and improve perfusion, which are crucial in managing DKA. Insulin therapy follows after fluid resuscitation to address the underlying cause of DKA, which is the lack of insulin leading to increased ketone production. Administering subcutaneous insulin (Choice A) would be premature without first addressing the dehydration and electrolyte imbalances. Giving oral glucose tablets (Choice B) is contraindicated in DKA as the patient already has high blood glucose levels. Administering oxygen therapy (Choice D) may be necessary based on the patient's condition, but addressing dehydration with intravenous fluids is the priority intervention in DKA.

3. When developing a behavior modification program for an extremely aggressive 10-year-old boy, what should the nurse do first?

• A. Identify what activities, foods, and toys the child enjoys
• B. Assess the child's previous reactions to punishment
• C. Offer the child positive feedback
• D. Involve other children on the unit in describing the token system

Correct answer: A

Rationale: The first step in developing a behavior modification program for an extremely aggressive 10-year-old boy is to identify what activities, foods, and toys the child enjoys. Understanding the child's motivations is crucial in creating an effective behavior modification plan tailored to his interests and preferences, which can help in positively reinforcing desired behaviors.

4. The healthcare provider is preparing to administer digoxin (Lanoxin) to a 6-month-old infant with heart failure. The healthcare provider notes that the infant’s heart rate is 90 beats per minute. What should the healthcare provider do next?

• A. Administer the medication as prescribed
• B. Hold the medication and notify the healthcare provider
• C. Reassess the heart rate in 30 minutes
• D. Administer half the prescribed dose

Correct answer: B

Rationale: In this scenario, the correct action is to hold the medication and notify the healthcare provider. Digoxin should be withheld if the infant’s heart rate is below 100 beats per minute. Administering digoxin in this situation can further slow down the heart rate in infants with heart failure, leading to potential adverse effects. Reassessing the heart rate in 30 minutes is not the best immediate action to take, as prompt notification and withholding of the medication are crucial. Administering the medication as prescribed or giving half the dose can exacerbate the situation by potentially further lowering the heart rate.

5. The healthcare provider is assessing a child for neurological soft signs. Which finding is most likely demonstrated in the child's behavior?

• A. Inability to move the tongue in a specific direction.
• B. Presence of vertigo.
• C. Poor coordination and sense of position.
• D. Loss of visual acuity.

Correct answer: C

Rationale: Neurological soft signs in children often manifest as poor coordination and a sense of position. These signs can indicate underlying neurological issues and are important to assess in pediatric patients. Choices A, B, and D are less likely to be associated with neurological soft signs in children. Inability to move the tongue in a specific direction may suggest a cranial nerve dysfunction rather than general neurological soft signs. Presence of vertigo is more related to inner ear disturbances or vestibular issues. Loss of visual acuity may indicate problems with the eyes rather than general neurological soft signs.

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