Nursing Elites

1. You are developing a plan of care for a hospitalized child. Which age group is most likely to view illness as a punishment for misdeeds?

• A. Adolescence
• B. Preschool age
• C. Infancy
• D. School age

Correct answer: B

Rationale: Preschool-aged children often engage in magical thinking, where they may believe that illness is a punishment for misdeeds. This belief is related to their cognitive development stage, where they may attribute cause and effect in a magical or unrealistic way. Adolescents are more likely to view illness as a disruption to their sense of independence or control. Infants lack the cognitive development to associate illness with punishment for misdeeds. School-aged children typically have a more concrete understanding of illness and its causes, moving away from magical thinking.

2. An infant with short bowel syndrome is receiving total parenteral nutrition (TPN). The practitioner has added continuous enteral feedings through a gastrostomy tube. The nurse recognizes this as important for which reason?

• A. Wean the infant from TPN gradually
• B. Stimulate adaptation of the small intestine
• C. Provide additional nutrients that cannot be included in the TPN
• D. Offer parents encouragement that the child is close to discharge

Correct answer: B

Rationale: Continuous enteral feedings help stimulate the small intestine's adaptation in short bowel syndrome, promoting better nutrient absorption and eventually reducing reliance on TPN. This approach is crucial for long-term management and improving the child's prognosis. Choice A is incorrect because weaning off TPN typically occurs gradually over time, not the next day. Choice C is incorrect because TPN can be adjusted to provide necessary nutrients, and enteral feedings are mainly used to stimulate intestinal function. Choice D is incorrect as the addition of enteral feedings does not necessarily indicate imminent discharge; it primarily focuses on enhancing intestinal adaptation and reducing reliance on TPN.

3. The nurse is evaluating research studies according to the GRADE criteria and has determined the quality of evidence on the subject is moderate. Which type of evidence does this determination indicate?

• A. Strong evidence from unbiased observational studies
• B. Evidence from randomized clinical trials showed inconsistent results
• C. Consistent evidence from well-performed randomized clinical trials
• D. Evidence for at least one critical outcome from randomized clinical trials had serious flaws

Correct answer: B

Rationale: Moderate evidence typically indicates that results from randomized clinical trials were inconsistent, highlighting the need for further research to confirm findings.

4. The nurse is using a bulb syringe to suction a neonate after delivery. What is an important consideration?

• A. Compress the bulb before insertion.
• B. Clear the mouth and pharynx before the nasal passages.
• C. Use two bulb syringes, one for the mouth and pharynx and one for the nasal passages.
• D. Continue using a bulb syringe until secretions are removed as mechanical suction is contraindicated.

Correct answer: B

Rationale: The correct consideration when using a bulb syringe to suction a neonate after delivery is to clear the mouth and pharynx before the nasal passages to prevent aspiration of amniotic fluid. Compressing the bulb syringe before insertion is important to create suction. Using two bulb syringes is unnecessary, as one is sufficient for both the mouth/pharynx and nasal passages. It is not recommended to continue using a bulb syringe until all secretions are removed; instead, mechanical suction can be employed if more forceful removal of secretions is required.

5. What is the most effective method to prevent infection in the newborn?

• A. Using disposable items
• B. Practicing proper hand hygiene by staff and family
• C. Administering prophylactic antibiotics
• D. Isolating the newborn from others

Correct answer: B

Rationale: The most effective method to prevent infection in newborns is by practicing proper hand hygiene by staff and family. This is crucial as it helps reduce the transmission of infectious agents, protecting vulnerable newborns. Using disposable items may help, but proper hand hygiene is more effective. Administering prophylactic antibiotics without a specific indication can lead to antibiotic resistance and is not recommended. Isolating the newborn from others is not practical and may not be necessary if proper hand hygiene is maintained.

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