Nursing Elites

1. When is it MOST appropriate to clamp and cut the umbilical cord?

• A. Before the newborn has taken its first breath
• B. After the placenta has completely delivered
• C. As soon as the cord has stopped pulsating
• D. Immediately following delivery of the newborn

Correct answer: C

Rationale: The ideal time to clamp and cut the umbilical cord is when it has stopped pulsating. This allows for the transfer of remaining blood from the placenta to the newborn, which can be beneficial for the baby's health and iron stores. Clamping the cord too early can deprive the newborn of this essential blood volume. Waiting for the pulsations to cease ensures that the baby receives the maximum benefits from delayed cord clamping.

2. A group of nursing students is discussing trends that influence pediatric health care today. The students' discussion focuses on which trends?

• A. Family-centered care
• B. Evidenced-based practice
• C. Nursing traditions
• D. A and B

Correct answer: D

Rationale: In pediatric health care, family-centered care and evidenced-based practice are crucial trends that impact care delivery. Family-centered care involves involving the family in decision-making and care planning, recognizing their role in the child's well-being. Evidenced-based practice ensures nursing interventions are based on the best available evidence to provide high-quality care to pediatric patients. Nursing traditions, though important, may not encompass the latest advancements in pediatric care. Therefore, choices A and B are correct as they represent current influential trends in pediatric health care.

3. What is the most likely cause of a sudden onset of respiratory distress in a 5-year-old child with no fever?

• A. Infection of the lower airways.
• B. A progressive upper airway infection.
• C. Inflammation of the upper airway.
• D. A foreign body airway obstruction.

Correct answer: D

Rationale: A sudden onset of respiratory distress in a child without fever is most likely due to a foreign body airway obstruction. This obstruction can rapidly lead to difficulty breathing, stridor, and other signs of respiratory distress without necessarily causing a fever. Prompt recognition and intervention are crucial in such cases to prevent further complications and ensure the child's airway remains clear.

4. Upon assessing a newborn immediately after delivery, you note that the infant is breathing spontaneously and has a heart rate of 80 beats/min. What is the MOST appropriate initial management for this newborn?

• A. Assess the newborn's skin condition and color.
• B. Initiate positive-pressure ventilations.
• C. Start chest compressions and contact medical control.
• D. Provide blow-by oxygen with oxygen tubing.

Correct answer: B

Rationale: In a newborn with a heart rate below 100 beats/min, the most appropriate initial management is to initiate positive-pressure ventilations. This helps support the newborn's respiratory effort and oxygenation in the setting of a low heart rate, ensuring adequate oxygen supply to vital organs. Assessing the skin condition and color, starting chest compressions, or providing blow-by oxygen are not the priority in this scenario where respiratory support is crucial.

5. Your assessment of a 5-year-old child reveals that he is unresponsive with a respiratory rate of 8 breaths/min and a heart rate of 50 beats/min. Treatment for this child should include:

• A. high-flow oxygen via non-rebreathing mask and rapid transport.
• B. assisted ventilation with a bag-mask device and rapid transport.
• C. positive-pressure ventilation, chest compressions, and rapid transport.
• D. back slaps and chest thrusts while attempting artificial ventilations.

Correct answer: C

Rationale: In a 5-year-old child who is unresponsive with severe bradycardia and bradypnea, the priority is to provide positive-pressure ventilation to support breathing and perform chest compressions to support circulation. This child is in cardiac arrest, and the recommended treatment according to pediatric basic life support guidelines involves a combination of positive-pressure ventilation and chest compressions to maintain oxygenation and circulation. Rapid transport to a medical facility for further advanced care is crucial in this critical situation. Choices A, B, and D are incorrect because high-flow oxygen via non-rebreathing mask, assisted ventilation with a bag-mask device, and back slaps with chest thrusts are not sufficient in a cardiac arrest situation where the child requires immediate positive-pressure ventilation and chest compressions to maintain oxygenation and circulation.

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