Nursing Elites

1. You have just delivered a baby girl. Your assessment of the newborn reveals that she has a patent airway, is breathing adequately, and has a heart rate of 130 beats/min. Her face and trunk are pink, but her hands and feet are cyanotic. You have clamped and cut the umbilical cord, but the placenta has not yet delivered. You should:

• A. reassess the newborn every 5 minutes and transport after the placenta delivers.
• B. keep the newborn warm, give oxygen to the mother if needed, and transport.
• C. massage the lower part of the mother's uterus until the placenta delivers.
• D. give the newborn high-flow oxygen via a non-rebreathing mask and transport.

Correct answer: B

Rationale: In this scenario, the appropriate action is to keep the newborn warm, ensure the mother receives oxygen if needed, and prepare for transport. The newborn is showing signs of central cyanosis (hands and feet being cyanotic), which can be due to various reasons, including inadequate oxygenation. Therefore, ensuring warmth and possible oxygen to the mother are important. Additionally, monitoring both the mother and baby during transport is crucial for their well-being.

2. Which of the following signs or symptoms is more common in children than adults following an isolated head injury?

• A. Changes in pupillary reaction
• B. Tachycardia and diaphoresis
• C. Nausea and vomiting
• D. Altered mental status

Correct answer: C

Rationale: Nausea and vomiting are more common in children than adults following an isolated head injury. Children often present with gastrointestinal symptoms like nausea and vomiting after a head injury due to differences in physiological responses compared to adults.

3. Jaundice in children can be either pathological or physiological. Which of these will you consider as more serious?

• A. Jaundice seen within 24 hours of life
• B. Jaundice seen at the palms and soles
• C. Jaundice appearing after 24 hours of life
• D. Jaundice seen after 14 days of life

Correct answer: A

Rationale: Jaundice seen within 24 hours of life is considered more serious in children as it can indicate pathological causes such as hemolytic disease or sepsis, which require prompt evaluation and management to prevent complications. Jaundice appearing within 24 hours of life is concerning due to the higher likelihood of severe conditions, while jaundice seen at the palms and soles is more likely due to physiological causes such as breast milk jaundice. Jaundice appearing after 24 hours or after 14 days of life may still require evaluation but is less urgent compared to jaundice within the first 24 hours.

4. Adoley has been presented at the OPD with the following clinical manifestations: crying easily, short attention span, inability to sit still, fatigue but unable to sleep at night, excessive sweating, increased heart rate, and blood pressure. Which of the following will be the appropriate diagnosis for Adoley?

• A. Autism
• B. Hyperthyroidism
• C. Hypoglycemia
• D. Pneumonia

Correct answer: B

Rationale: The symptoms described in the case, such as excessive sweating, increased heart rate, and inability to sleep, are indicative of hyperthyroidism. Hyperthyroidism is characterized by an overactive thyroid gland, leading to symptoms like increased heart rate, sweating, and difficulty sleeping, which align with Adoley's clinical manifestations. Therefore, the appropriate diagnosis for Adoley would be hyperthyroidism.

5. Which of the following is the MOST detrimental effect of gastric distention in infants and children?

• A. Tracheal rupture.
• B. Less effective chest compressions.
• C. Decreased ventilatory volume.
• D. Acute rupture of the diaphragm.

Correct answer: C

Rationale: Gastric distention in infants and children can lead to a decrease in ventilatory volume. This occurs because the distended stomach can limit the movement of the diaphragm, reducing its ability to contract and expand the chest cavity effectively. As a result, the amount of air entering and leaving the lungs is decreased, impacting ventilation. Tracheal rupture, acute rupture of the diaphragm, and less effective chest compressions are not typically associated with gastric distention.

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