Nursing Elites

1. What is the priority assessment for a nurse when caring for an infant suspected of having necrotizing enterocolitis (NEC)?

• A. Hold feedings.
• B. Check gastric residuals before feedings.
• C. Take rectal temperature.
• D. Closely monitor abdominal distention.

Correct answer: D

Rationale: The correct answer is D: Closely monitor abdominal distention. Monitoring the abdomen for signs of distention is crucial in the early detection of necrotizing enterocolitis (NEC). In NEC, the bowel wall is edematous and breaking down, leading to abdominal distention. Holding feedings is important in the management of NEC, as feedings may need to be stopped temporarily. Checking gastric residuals before feedings helps in assessing the infant's tolerance to feedings. Taking rectal temperatures is contraindicated in NEC as it can lead to the perforation of the bowel.

2. The parents of a child with acute postinfectious glomerulonephritis (APIGN) ask how they will know that the condition is improving. How should the nurse respond?

• A. Your child’s urine output will increase, and the urine will become less brown in color.
• B. Your child will rest more comfortably.
• C. Your child’s appetite will decrease.
• D. Your child’s laboratory test values will show increased BUN.

Correct answer: A

Rationale: Improvement in APIGN is indicated by an increase in urine output and a change in urine color from brown (due to hematuria) to a more normal appearance. This reflects a reduction in glomerular inflammation and improved kidney function. Choice B is incorrect because resting more comfortably is not a direct indicator of kidney function improvement. Choice C is incorrect because a decrease in appetite is not typically associated with improvement in APIGN. Choice D is incorrect because an increased BUN value would suggest worsening kidney function rather than improvement.

3. Which nursing intervention should be included in the postoperative care of a child following a tonsillectomy?

• A. Encourage the child to blow the nose gently
• B. Notify the physician if mucus is observed in the emesis
• C. Position the child supine in the immediate postoperative period
• D. Avoid giving citrus juice

Correct answer: D

Rationale: The correct answer is D: 'Avoid giving citrus juice.' Citrus juice can irritate the throat after a tonsillectomy, so it should be avoided. Choice A is incorrect because blowing the nose gently is not a recommended intervention following a tonsillectomy. Choice B is incorrect as mucus in emesis is not uncommon postoperatively and does not necessarily require physician notification. Choice C is incorrect as positioning the child supine immediately postoperatively can increase the risk of airway obstruction and should be avoided.

4. The parents of a newborn with an umbilical hernia ask about treatment options. The nurse's response should be based on which knowledge?

• A. Surgery is recommended as soon as possible.
• B. The defect usually resolves spontaneously by 3 to 5 years of age.
• C. Aggressive treatment is necessary to reduce its high mortality.
• D. Taping the abdomen to flatten the protrusion is not recommended.

Correct answer: B

Rationale: The correct answer is B. Most umbilical hernias in newborns resolve on their own by 3 to 5 years of age without the need for surgical intervention, unless complications arise. Surgery is not typically recommended for umbilical hernias in newborns due to the high rate of spontaneous resolution. Aggressive treatment is not necessary as umbilical hernias are typically benign and not associated with high mortality. Taping the abdomen is not recommended as it can cause skin irritation and does not speed up the resolution of the hernia.

5. What clinical manifestation(s) is associated with calcium depletion (hypocalcemia)?

• A. Nausea, vomiting
• B. Weakness, fatigue
• C. Muscle hypotonicity
• D. Neuromuscular irritability

Correct answer: D

Rationale: Hypocalcemia can lead to neuromuscular irritability, causing symptoms such as muscle cramps, tetany, or seizures. Other symptoms like nausea, vomiting, and weakness are less specific and can be related to various conditions.

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