Nursing Elites

1. In a case where a limb is protruding from a mother's vagina during active labor, how should this condition be managed?

• A. Positioning the mother in a semi-Fowler's position, administering oxygen, and providing transport
• B. Positioning the mother in a head-down position with her hips elevated, administering oxygen, and providing transport
• C. Applying gentle traction to the protruding limb to remove pressure of the fetus from the umbilical cord
• D. Giving the mother 100% oxygen and attempting to manipulate the protruding limb so that delivery can occur

Correct answer: B

Rationale: When a limb is protruding from the vagina during active labor, the appropriate management includes positioning the mother in a head-down position with her hips elevated. This position helps relieve pressure on the umbilical cord, reducing the risk of compromising fetal blood flow and oxygenation. Administering oxygen is essential to maintain oxygenation levels for both the mother and the fetus. Providing transport to a healthcare facility equipped to manage this obstetric emergency is crucial for ensuring a safe delivery. Choice A is incorrect because a semi-Fowler's position does not effectively relieve pressure on the umbilical cord. Choice C is incorrect as applying traction to the protruding limb can lead to injury or complications for both the mother and the fetus. Choice D is incorrect because attempting to manipulate the limb without proper positioning and preparation can worsen the situation and increase risks during delivery.

2. Where should the child admitted with injuries that may be related to abuse be placed?

• A. In a private room
• B. With an older, friendly child
• C. With a child of the same age
• D. In a room near the nurses’ desk

Correct answer: D

Rationale: The correct answer is to place the child in a room near the nurses’ desk. This placement allows for close monitoring and immediate intervention if needed, ensuring the safety and well-being of the child. Placing the child in a private room (Choice A) may limit visibility and monitoring. Putting the child with an older, friendly child (Choice B) or a child of the same age (Choice C) does not prioritize the necessary close monitoring and intervention that a child potentially experiencing abuse requires. Hence, placing the child in a room near the nurses’ desk is the most appropriate choice in this scenario.

3. A child is being assessed for suspected appendicitis. What clinical manifestation is the healthcare professional likely to observe?

• A. Right lower quadrant pain
• B. Left lower quadrant pain
• C. Rebound tenderness
• D. Epigastric pain

Correct answer: A

Rationale: Right lower quadrant pain is a classic symptom of appendicitis. The appendix is typically located in the right lower quadrant of the abdomen, so pain in this area is commonly associated with appendicitis. Choices B, C, and D are incorrect because left lower quadrant pain, rebound tenderness, and epigastric pain are not typical manifestations of appendicitis. Left lower quadrant pain is not associated with appendicitis since the appendix is situated in the right lower quadrant. Rebound tenderness is more commonly linked with peritonitis rather than appendicitis. Epigastric pain is not a typical presentation of appendicitis as the pain is usually localized to the right lower quadrant.

4. An infant who had cardiac surgery for a congenital defect is to be discharged. What should the nurse emphasize to the parents regarding administering the prescribed antibiotic?

• A. Give the antibiotic between feedings.
• B. Ensure that the antibiotic is administered as prescribed.
• C. Shake the bottle thoroughly before administering the antibiotic.
• D. Keep the antibiotic in the refrigerator after opening the bottle.

Correct answer: B

Rationale: The correct answer is B: 'Ensure that the antibiotic is administered as prescribed.' It's crucial to stress the importance of following the prescribed antibiotic regimen to prevent infections and promote proper healing after cardiac surgery. Choice A is incorrect because it does not address the fundamental aspect of adherence to the prescription. Choice C is incorrect as shaking the bottle may not be necessary for all antibiotics and is not a critical instruction in this context. Choice D is incorrect as storage instructions are not directly related to the administration of the antibiotic as prescribed, which is the primary concern in this scenario.

5. When assessing the perfusion status of a 2-year-old child with possible shock, which of the following parameters would be LEAST reliable?

• A. distal capillary refill
• B. systolic blood pressure
• C. skin color and temperature
• D. presence of peripheral pulses

Correct answer: B

Rationale: The correct answer is B: systolic blood pressure. In young children, systolic blood pressure is the least reliable parameter for assessing perfusion status. Factors such as anxiety, crying, and fear can significantly affect blood pressure measurements, leading to inaccuracies. Distal capillary refill, skin color and temperature, and presence of peripheral pulses are more reliable indicators of perfusion status in pediatric patients. Distal capillary refill assesses peripheral perfusion, skin color, and temperature reflect tissue perfusion, and the presence of peripheral pulses indicates blood flow to the extremities. Therefore, when evaluating a 2-year-old child with possible shock, focusing on parameters other than systolic blood pressure is crucial for an accurate assessment of perfusion status.

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