Nursing Elites

1. What is the first action to take before administering tube feeding to an infant?

• A. Irrigate the tube with water.
• B. Offer a pacifier to the infant.
• C. Slowly instill 10 mL of formula.
• D. Place the infant in the Trendelenburg position.

Correct answer: B

Rationale: The correct first action before administering tube feeding to an infant is to offer a pacifier. Providing a pacifier stimulates the sucking reflex, aiding in digestion and providing comfort to the infant. Irrigating the tube with water (Choice A) is not typically the initial step and could potentially introduce unnecessary fluid into the infant's system. Slowly instilling formula (Choice C) should only be done after ensuring the tube is appropriately placed. Placing the infant in the Trendelenburg position (Choice D) is not necessary for tube feeding and could pose risks such as aspiration.

2. A school nurse is educating parents of school-age children on the significance of immunizations for childhood communicable diseases. What preventable disease may lead to the complication of encephalitis?

• A. Varicella (Chickenpox)
• B. Scarlet fever
• C. Poliomyelitis
• D. Whooping cough

Correct answer: A

Rationale: The correct answer is A: Varicella (Chickenpox). Varicella can lead to the complication of encephalitis, characterized by brain inflammation. Encephalitis is a known complication of chickenpox in rare cases. Scarlet fever (choice B) is caused by Streptococcus bacteria and does not typically result in encephalitis. Poliomyelitis (choice C) primarily affects the spinal cord and does not lead to encephalitis. Whooping cough (choice D) can cause severe coughing spells but does not directly result in encephalitis.

3. What is the nurse’s priority intervention when preparing for admission of a child with acute laryngotracheobronchitis?

• A. Pad the side rails of the crib.
• B. Arrange for a quiet, cool room.
• C. Place a tracheotomy set at the bedside.
• D. Obtain a recliner so that a parent can stay.

Correct answer: C

Rationale: The correct answer is to place a tracheotomy set at the bedside. Acute laryngotracheobronchitis can cause airway obstruction, which may require an emergency tracheotomy. Having the tracheotomy set readily available ensures quick access in case of respiratory distress. Padding the side rails of the crib, arranging for a quiet, cool room, and obtaining a recliner for a parent are important aspects of care but are not the priority when managing a potentially life-threatening airway emergency.

4. The nurse is teaching a parent group about the reasons for adhering to the immunization schedule. What complication of mumps is important for adolescents to avoid?

• A. Sterility
• B. Hypopituitarism
• C. Decrease in libido
• D. Decrease in androgens

Correct answer: A

Rationale: The correct answer is A: Sterility. Mumps can lead to serious complications such as sterility, especially in adolescent males. Vaccination is essential to prevent this potential outcome. Hypopituitarism (Choice B) is not a typical complication of mumps. Choices C and D, decrease in libido and decrease in androgens, are not directly associated with mumps complications, particularly in the context of adolescents.

5. At 7 AM, a healthcare professional receives the information that an adolescent with diabetes has a 6:30 AM fasting blood glucose level of 180 mg/dL. What is the priority nursing action at this time?

• A. Encourage the adolescent to start exercising.
• B. Ask the adolescent to obtain an immediate glucometer reading.
• C. Inform the adolescent that a complex carbohydrate such as cheese should be eaten.
• D. Tell the adolescent that the prescribed dose of rapid-acting insulin should be administered.

Correct answer: D

Rationale: The correct priority nursing action in this situation is to administer the prescribed dose of rapid-acting insulin. Rapid-acting insulin is necessary to help lower the elevated blood glucose level quickly, thereby preventing potential complications of hyperglycemia. Encouraging exercise, obtaining a glucometer reading, or suggesting consumption of complex carbohydrates like cheese may not address the immediate need to bring down the high blood glucose level effectively. Exercise could potentially raise blood glucose levels, obtaining a glucometer reading may delay necessary treatment, and consuming complex carbohydrates can further elevate blood glucose levels in this scenario.

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