Nursing Elites

1. The parents of a newborn male with hypospadias want their child circumcised. The best response by the nurse is to inform them that

• A. Circumcision is delayed so the foreskin can be used for the surgical repair
• B. This procedure is contraindicated because of the permanent defect
• C. There is no medical indication for performing a circumcision on any child
• D. The procedure should be performed as soon as the infant is stable

Correct answer: A

Rationale: Circumcision is delayed so the foreskin can be used for the surgical repair. Even if mild hypospadias is suspected, circumcision is not done to save the foreskin for surgical repair if needed. Choice B is incorrect because circumcision is not contraindicated due to a permanent defect; it is delayed for potential surgical needs. Choice C is incorrect as there are situations where a circumcision may be indicated for medical or cultural reasons. Choice D is incorrect because circumcision for hypospadias-related repair is not done immediately but rather delayed to preserve the foreskin for potential reconstructive surgery.

2. A 16-month-old child has just been admitted to the hospital. As the nurse assigned to this child enters the hospital room for the first time, the toddler runs to the mother, clings to her, and begins to cry. What would be the initial action by the nurse?

• A. Arrange to change client care assignments
• B. Explain that this behavior is expected
• C. Discuss the appropriate use of 'time-out'
• D. Explain that the child needs extra attention

Correct answer: B

Rationale: When encountering a 16-month-old child exhibiting fear of strangers by clinging to the parent and crying, it is essential for the nurse to explain that this behavior is expected. Fear of strangers typically emerges around 6-8 months of age and can continue into the toddler years and beyond. This behavior is a normal part of development as the child is displaying attachment and trust in familiar caregivers. Changing client care assignments, discussing 'time-out,' or suggesting the child needs extra attention are not appropriate initial actions in this situation. Changing care assignments is unnecessary and does not address the child's emotional needs. Discussing 'time-out' is not relevant as it pertains to discipline strategies for older children. Suggesting the child needs extra attention may misinterpret the situation; the child's behavior is a normal response to a new environment and does not necessarily indicate a need for additional attention.

3. A patient is suspected to have sustained a spinal cord injury. What best describes the overarching principles used to guide the care for this type of condition?

• A. Immobilize the cervical area to prevent further injury
• B. Monitor the patient's level of consciousness to prevent neurologic deterioration
• C. Help the patient with activities of daily living and provide emotional and physical support to help them adjust to their injury
• D. Facilitate tissue perfusion to the spinal cord while maintaining airway and breathing

Correct answer: D

Rationale: The correct answer is to facilitate tissue perfusion to the spinal cord while maintaining airway and breathing. In the acute phase of a spinal cord injury, ensuring proper tissue perfusion to the spinal cord is crucial to prevent further damage. Maintaining airway, breathing, and circulation is essential in guiding the overall care for a patient with a spinal cord injury. Choices A, B, and C, while important in certain aspects of care, are not the overarching principles that guide the immediate management of a suspected spinal cord injury.

4. When administering a shot of Vitamin K to a 30-day-old infant, which of the following target areas is the most appropriate?

• A. Gluteus maximus
• B. Gluteus minimus
• C. Vastus lateralis
• D. Vastus medialis

Correct answer: C

Rationale: When administering medications to infants, it is common to use the vastus lateralis muscle in the thigh for injections. The preferred site is the junction of the upper and middle thirds of the vastus lateralis muscle. This area provides a good muscle mass for the injection and minimizes the risk of hitting nerves or blood vessels. The gluteus maximus and gluteus minimus are not typically used for infant injections due to the risk of injury to the sciatic nerve. The vastus medialis is not as commonly used as the vastus lateralis for infant injections.

5. The healthcare provider is reviewing the lab results of a patient who has presented in the Emergency Room. The lab results show that the troponin T value is at 5.3 ng/mL. Which of these interventions, if not already completed, would take priority over the others?

• A. Place the patient in a 90-degree position
• B. Assess whether the patient is taking diuretics
• C. Obtain and attach defibrillator leads
• D. Assess the patient's last ejection fraction

Correct answer: C

Rationale: In this scenario, the elevated Troponin T level indicates cardiac damage, possibly due to a myocardial infarction. A Troponin T value of 5.3 ng/mL is significantly elevated (normal levels are below 0.2 ng/mL), suggesting acute cardiac injury. Given the setting of an Emergency Room and the critical nature of the situation, the priority intervention should be to obtain and attach defibrillator leads. Elevated Troponin T levels can indicate a higher risk of arrhythmias, including ventricular fibrillation, which can lead to sudden cardiac arrest. Defibrillator leads are essential for monitoring the patient's cardiac rhythm and readiness for immediate defibrillation if necessary. Placing the patient in a 90-degree position (Choice A) or assessing diuretic use (Choice B) are not immediate priorities in this critical situation. Additionally, assessing the patient's last ejection fraction (Choice D) is important but not as urgent as preparing for potential life-threatening arrhythmias requiring defibrillation.

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