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. An infant who has had diarrhea for 3 days is admitted in a lethargic state and is breathing rapidly. The parent states that the baby has been ingesting formula, although not as much as usual, and cannot understand the sudden change. What explanation should the nurse give the parent?

• A. Cellular metabolism is unstable in young children.
• B. The proportion of water in the body is less than in adults.
• C. Renal function is immature in children until they reach school age.
• D. The extracellular fluid requirement per unit of body weight is greater than in adults.

Correct answer: D

Rationale: The correct answer is D. Infants have a higher extracellular fluid requirement per unit of body weight, making them more susceptible to dehydration and electrolyte imbalances during illnesses such as diarrhea. Choice A is incorrect as cellular metabolism instability does not directly relate to the infant's condition described. Choice B is inaccurate as the proportion of water in the body is not the primary issue causing the infant's symptoms. Choice C is incorrect as renal function being immature does not explain the sudden change in the infant's health status; it is more related to fluid balance and dehydration.

3. An 18-month-old was brought to the emergency department by her mother, who states, 'I think she broke her arm.' The child is sent for a radiograph to confirm the fracture. Additional assessment of the child leads the nurse to suspect possible child abuse. Which type of fracture would the radiograph most likely reveal?

• A. Plastic deformity
• B. Buckle fracture
• C. Spiral fracture
• D. Greenstick fracture

Correct answer: C

Rationale: A spiral fracture is a type of fracture often associated with twisting injuries and can raise suspicion of child abuse. This type of fracture is caused by a twisting force applied to a bone. Plastic deformity is not typically associated with fractures but refers to the ability of a material to change shape and retain that shape. A buckle fracture, also known as a torus fracture, is an incomplete break in a bone commonly seen in children. A greenstick fracture is an incomplete fracture where the bone is bent and partially broken, more commonly seen in children due to their bone flexibility.

4. What treatment should the nurse suggest to an adolescent with type 1 diabetes if an insulin reaction is experienced while at a basketball game?

• A. Call your parents immediately.
• B. Buy a soda and hamburger to eat.
• C. Administer insulin as soon as possible.
• D. Leave the arena and rest until the symptoms subside.

Correct answer: B

Rationale: When an adolescent with type 1 diabetes experiences an insulin reaction, it is essential to quickly raise their blood sugar levels. Buying a soda and a hamburger to eat is the best choice in this situation as it provides a fast-acting source of sugar to counteract hypoglycemia. Calling parents immediately may cause a delay in receiving appropriate treatment. Administering insulin would further lower blood sugar levels, worsening the situation. Leaving the arena and resting would not address the immediate need to raise blood sugar levels.

5. A parent tells the nurse, “My 9-month-old baby no longer has the same strong grasp that was present at birth and no longer acts startled by loud noises.” How should the nurse explain these changes in behavior?

• A. “I will check these responses before deciding how to proceed.”
• B. “Failure of these responses may be related to a developmental delay.”
• C. “Additional sensory stimulation is needed to aid in the return of these responses.”
• D. “These responses are replaced by voluntary activity at about five months of age.”

Correct answer: D

Rationale: The correct answer is D. The grasp reflex and startle reflex (Moro reflex) are normal in newborns but typically disappear as the infant's nervous system matures and voluntary control develops. At around five months of age, these reflexes are replaced by voluntary movements as part of the normal developmental process. Choices A, B, and C are incorrect. Choice A suggests delaying a decision until further assessment, which is not necessary as the disappearance of these reflexes is a normal part of infant development. Choice B implies a developmental delay, which is not the case as these reflexes naturally disappear with age. Choice C recommending additional sensory stimulation is unnecessary and not the reason for the absence of these reflexes.

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