Nursing Elites

1. What factor predisposes an infant to fluid imbalances?

• A. Decreased surface area
• B. Lower metabolic rate
• C. Immature kidney functioning
• D. Decreased daily exchange of extracellular fluid

Correct answer: C

Rationale: Infants have immature kidneys that are less efficient at concentrating urine, making them more susceptible to fluid imbalances. Their higher surface area to volume ratio also contributes to greater insensible fluid losses.

2. The nurse is caring for a child with hypernatremia. The nurse evaluates the child for which signs and symptoms of hypernatremia? (Select all that apply.)

• A. All below
• B. Lethargy
• C. Oliguria
• D. Intense thirst

Correct answer: A

Rationale: Hypernatremia typically presents with lethargy, oliguria, and intense thirst due to the body's attempt to conserve water. Apathy can also occur, but lethargy and thirst are more consistent indicators.

3. A 14-year-old with chronic renal failure suddenly becomes non-compliant with the medication regimen. Which nursing intervention would most likely improve compliance?

• A. Give the child a computer-animated game that presents information on the management of chronic renal failure.
• B. Set up a meeting with some older teens who have chronic renal failure and have been managing their disease effectively.
• C. Arrange for a physician to sit down and talk to the child about the risks related to noncompliance with medications.
• D. Discuss with the child’s parents that privileges, such as a cell phone, can be taken away if compliance fails to improve.

Correct answer: B

Rationale: Adolescents often seek guidance and support from their peers. Setting up a meeting with older teens who are effectively managing chronic renal failure can provide the 14-year-old with motivation, encouragement, and practical advice on how to handle their treatment regimen. This peer support can positively influence the non-compliant adolescent, making choice B the most likely intervention to improve compliance. Choices A and C may not address the peer influence aspect of adolescent behavior, while choice D focuses on punitive measures rather than addressing the underlying reasons for non-compliance.

4. The mother of a 6-month-old infant has returned to work and is expressing breast milk to be frozen. She asks for directions on how to safely thaw the breast milk in the microwave. What should the nurse recommend?

• A. Heat only 10 oz or more.
• B. Do not thaw or heat breast milk in a microwave oven.
• C. Always leave the bottle top uncovered to allow heat to escape.
• D. Shake the bottle vigorously for at least 30 seconds after heating.

Correct answer: B

Rationale: Thawing or heating breast milk in a microwave is not recommended because it can create hot spots that may burn the infant and destroy essential nutrients.

5. Which developmental milestone would the nurse expect an 11-month-old infant to have achieved?

• A. Sitting independently
• B. Turning a doorknob
• C. Building a tower of four cubes
• D. Walking independently

Correct answer: A

Rationale: The correct answer is A: Sitting independently. By 11 months, most infants can sit independently. This milestone usually precedes walking, which typically occurs closer to 12 months. Turning a doorknob and building a tower of four cubes involve more complex motor skills that are typically achieved later in development. Therefore, at 11 months, sitting independently is the milestone that the nurse would expect an infant to have achieved.

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