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. While caring for a 5-year-old child hospitalized for the treatment of acute lymphoblastic leukemia (ALL), what is the priority nursing intervention?

• A. Administering antibiotics
• B. Preventing infection
• C. Providing nutritional support
• D. Managing pain

Correct answer: B

Rationale: The priority nursing intervention for a child with acute lymphoblastic leukemia (ALL) is preventing infection due to their compromised immune system. Children undergoing treatment for ALL are highly susceptible to infections, making infection prevention crucial for the child's well-being and treatment success. Administering antibiotics, though important in specific cases, is not the priority in this scenario. Providing nutritional support and managing pain are significant aspects of care but take a back seat to infection prevention in this situation.

3. What behavior does a toddler subjected to prolonged hospitalization with limited parental visits typically exhibit?

• A. Cheerful interactions with staff members
• B. Indications of sadness throughout the day
• C. Excessive crying when parents are not present
• D. Limited emotional response to the environment

Correct answer: D

Rationale: Toddlers subjected to prolonged hospitalization with limited parental visits often exhibit a limited emotional response to the environment. This behavior is a common coping mechanism in young children facing such situations. While cheerful interactions with staff members (choice A) may occur occasionally, the overall response tends to be subdued. Indications of sadness throughout the day (choice B) and excessive crying when parents are not present (choice C) are less typical in this scenario, as the child may have learned to suppress emotions due to the challenging circumstances.

4. During a primary survey of a child with partial thickness burns over the upper body areas, what action should the nurse take first?

• A. Inspect the child's skin color.
• B. Assess for a patent airway.
• C. Observe for symmetric breathing.
• D. Palpate the child's pulse.

Correct answer: B

Rationale: The correct answer is B: Assess for a patent airway. When dealing with a child who has sustained partial thickness burns, the priority is ensuring a patent airway due to the risk of respiratory compromise. Checking the child's skin color (choice A) may be important but is secondary to assessing the airway. While observing for symmetric breathing (choice C) is crucial, assessing the airway takes precedence in this situation. Palpating the child's pulse (choice D) is not the initial priority when managing burns and potential airway compromise.

5. The nurse is assessing a 9-year-old girl with a history of tuberculosis at age 6 years. She has been losing weight and has no appetite. The nurse suspects Addison disease based on which assessment findings?

• A. Arrested height and increased weight
• B. Thin, fragile skin and multiple bruises
• C. Hyperpigmentation and hypotension
• D. Blurred vision and enuresis

Correct answer: C

Rationale: The correct answer is C: Hyperpigmentation and hypotension. These findings are classic signs of Addison disease, caused by adrenal insufficiency. Hyperpigmentation results from increased ACTH stimulating melanin production, and hypotension occurs due to mineralocorticoid deficiency. Choices A, B, and D are incorrect. Arrested height and increased weight are not typical of Addison disease. Thin, fragile skin and multiple bruises are seen in conditions like Cushing's syndrome, not Addison disease. Blurred vision and enuresis are not characteristic symptoms of Addison disease.

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