Nursing Elites

1. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 90 beats/min. What is the most appropriate initial management for this newborn?

• A. begin positive pressure ventilations
• B. provide blow-by oxygen with oxygen tubing
• C. assess the newborn's skin condition and color
• D. start chest compressions and contact medical control

Correct answer: A

Rationale: A heart rate below 100 beats/min in a newborn indicates the need for positive pressure ventilation to improve oxygenation. Providing positive pressure ventilations helps in assisting the newborn's breathing efforts to ensure adequate oxygenation. Choice B, providing blow-by oxygen, may not be sufficient to address the underlying issue of inadequate breathing. Choice C, assessing the newborn's skin condition and color, is important but not the most immediate action needed for a heart rate below 100 beats/min. Choice D, starting chest compressions, is not indicated as the infant is breathing spontaneously and has a heart rate, albeit lower than normal, which does not warrant chest compressions.

2. The nurse is caring for a child and family who just moved out of a dangerous neighborhood. Which of the following approaches is appropriate based on the family stress theory?

• A. Determining who the decision-maker is
• B. Assessing the child's coping abilities
• C. Exploring how a sibling feels
• D. Explaining procedures to a sibling

Correct answer: B

Rationale: Assessing the child's coping abilities is appropriate based on the family stress theory because it helps the nurse understand how well the child can manage and adapt to the stressors related to the move. This assessment can guide interventions to support the child's emotional well-being and adjustment. Choices A, C, and D are not directly related to assessing the child's coping abilities and may not address the child's immediate needs during this stressful time.

3. When preparing a 2-year-old child for surgery, what preoperative teaching should be provided to help them understand the procedure?

• A. Explaining the procedure in simple terms
• B. Using a doll to demonstrate the procedure
• C. Showing pictures of the hospital environment
• D. Allowing the child to play with medical equipment

Correct answer: B

Rationale: The correct preoperative teaching for a 2-year-old child undergoing surgery involves using a doll to demonstrate the procedure. This method helps the child understand what to expect in a non-threatening and visual way, making the experience less intimidating. Explaining the procedure in simple terms (Choice A) may not effectively convey the details to a young child. Showing pictures of the hospital environment (Choice C) may not directly address the surgical procedure itself. Allowing the child to play with medical equipment (Choice D) can be unsafe and may not effectively prepare the child for the surgery.

4. A 7-year-old child has an altered mental status, high fever, and a generalized rash. You perform your assessment and initiate oxygen therapy. En route to the hospital, you should be most alert for:

• A. vomiting
• B. seizures
• C. combativeness
• D. respiratory distress

Correct answer: B

Rationale: In a pediatric patient presenting with altered mental status, high fever, and a generalized rash, seizures are a significant concern. Febrile seizures can occur in children with high fevers and may lead to further complications. It is crucial to monitor for seizures and be prepared to manage them promptly. Vomiting, combativeness, and respiratory distress are also important considerations in pediatric patients; however, given the clinical presentation described, seizures take priority as they are a common complication in this scenario.

5. A child with a diagnosis of nephrotic syndrome is being discharged. What dietary instructions should the nurse provide?

• A. Encourage a high-protein diet
• B. Avoid foods high in salt
• C. Encourage a low-sodium diet
• D. Encourage a low-protein diet

Correct answer: B

Rationale: For a child with nephrotic syndrome, it is important to avoid foods high in salt. This instruction helps manage symptoms and prevent complications associated with the condition. High salt intake can lead to fluid retention and worsen edema, which are common issues in nephrotic syndrome. Encouraging a low-sodium diet is crucial to maintaining fluid balance and reducing strain on the kidneys. Choices A, C, and D are incorrect because a high-protein diet can further stress the kidneys, while a low-protein diet may not be necessary unless specifically advised by the healthcare provider. Encouraging a low-sodium diet is more appropriate for managing nephrotic syndrome.

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