Nursing Elites

1. What is typically the first sign of puberty in females?

• A. Breast development
• B. Menarche
• C. Pubic hair growth
• D. Axillary hair growth

Correct answer: A

Rationale: The correct answer is A: Breast development (thelarche) is usually the first sign of puberty in females, typically beginning between ages 8 and 13. This marks the start of puberty, followed by pubic hair growth, a growth spurt, and eventually menarche (the onset of menstruation). Pubic hair growth and axillary hair growth usually follow breast development in the sequence of pubertal changes. Therefore, the first noticeable change indicating the onset of puberty in females is the development of breast buds.

2. A mother has just given birth to a newborn with a cleft lip. Sensing that something is wrong, she starts to cry and asks the nurse, "What is wrong with my baby?" What is the most appropriate nursing action?

• A. Encourage the mother to express her feelings
• B. Explain in simple language that the baby has a cleft lip
• C. Provide emotional support until the practitioner can talk to the mother
• D. Tell the mother a pediatrician will talk to her as soon as the baby is examined

Correct answer: A

Rationale: Encouraging the mother to express her feelings allows her to process the situation and prepares her for receiving further information in a supportive environment.

3. The nurse is assessing a 3-day-old breastfed newborn who weighed 3400 g (7 pounds, 8 oz) at birth. The infant’s mother is now concerned because the infant weighs 3147 g (6 pounds, 15 oz). The most appropriate nursing intervention is what?

• A. Recommend supplemental feedings of formula.
• B. Explain that this weight loss is within normal limits.
• C. Assess the child further to determine the cause of excessive weight loss.
• D. Encourage the mother to express breast milk for bottle-feeding the infant.

Correct answer: B

Rationale: A neonate normally loses about 10% of the birth weight by age 3 to 4 days. The birth weight is usually regained by the 10th day of life. In this case, the weight loss from 3400 g to 3147 g is within the expected range. Therefore, the most appropriate action is to explain to the mother that this weight loss is within normal limits. Choice A is incorrect because supplemental feedings of formula are not indicated for this expected weight loss in a breastfed newborn. Choice C is incorrect as there is no evidence to suggest excessive weight loss at this point. Choice D is unnecessary at this stage and may not align with the current situation of normal weight loss post-birth.

4. The parent of a 3-month-old infant is concerned because the infant is not able to sit independently. How should the nurse respond to this parent's concern?

• A. Sitting ability and the age of first tooth eruption are not correlated.
• B. Most infants sit steadily at 4 months.
• C. Most infants sit steadily at 3 months.
• D. Most infants do not sit steadily until 6-8 months.

Correct answer: D

Rationale: The correct answer is D because sitting steadily typically occurs closer to 6-8 months of age, not 3 or 4 months. Choice A is incorrect because sitting ability and the age of first tooth eruption are not related. Choice B and C are incorrect as most infants do not sit steadily at 3 or 4 months, and it is more common for infants to achieve this milestone around 6-8 months.

5. Which dietary information should the nurse include in the teaching plan for a school-age child with chronic renal failure?

• A. High in sodium
• B. Low in Vitamin D
• C. Low in phosphorus
• D. Supplementation of vitamins C, E, K

Correct answer: C

Rationale: A low-phosphorus diet is recommended for children with chronic renal failure to prevent hyperphosphatemia, which can lead to bone disease and other complications. Phosphorus is found in many processed foods and should be limited. Choices A, B, and D are incorrect because high sodium intake can lead to fluid retention and hypertension, while Vitamin D supplementation and vitamins C, E, K are not specifically indicated for dietary recommendations in chronic renal failure.

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