Nursing Elites

1. Your assessment of a newborn reveals cyanosis to the chest and face and a heart rate of 90 beats/min. What should you do first?

• A. Dry the infant briskly.
• B. Suction the mouth.
• C. Begin artificial ventilations.
• D. Begin chest compressions.

Correct answer: C

Rationale: In a newborn with cyanosis to the chest and face and a heart rate of 90 beats/min, the priority action is to begin artificial ventilations. A heart rate below 100 beats/min with cyanosis indicates a need for immediate respiratory support to improve oxygenation. Drying the infant briskly or suctioning the mouth may be necessary later but are not the initial priority. Chest compressions are not indicated as the heart rate is above 60 beats/min.

2. Why should small children ride in the backseat of a vehicle?

• A. They are much less likely to be ejected from the vehicle.
• B. The back of the front seat will provide a cushion during a crash.
• C. They can experience severe injury or death if the airbag deploys.
• D. Their legs are highly prone to injury from striking the dashboard.

Correct answer: C

Rationale: Small children should ride in the backseat of a vehicle primarily to avoid severe injury or death that may occur if the airbag deploys. In the event of a crash, the force of an airbag deployment can be dangerous for a child seated in the front seat. Placing them in the backseat reduces the risk of serious harm from airbag impact and is a safer seating position for young passengers.

3. The caregiver is teaching a new mother about infant safety. Which statement indicates that further teaching is needed?

• A. I will place my baby on their back to sleep.
• B. I will keep soft toys and pillows out of the crib.
• C. I will use a car seat for every car ride.
• D. I will allow my baby to sleep in my bed.

Correct answer: D

Rationale: Allowing a baby to sleep in an adult bed increases the risk of suffocation and Sudden Infant Death Syndrome (SIDS). It is safer for infants to sleep on a firm, flat surface in their own crib or bassinet to reduce the risk of accidental suffocation or strangulation. Therefore, the caregiver should be advised against co-sleeping with the infant to ensure the baby's safety.

4. A toddler is admitted to the hospital because of sudden hoarseness, holding or pointing to their neck, and continuous cough. The nurse will be particularly concerned about:

• A. Acute respiratory tract infection
• B. Respiratory tract obstruction caused by a foreign body
• C. Retropharyngeal abscess
• D. Undetected laryngeal abnormality

Correct answer: B

Rationale: In a toddler presenting with sudden hoarseness, holding or pointing to their neck, and continuous cough, the nurse should be particularly concerned about respiratory tract obstruction caused by a foreign body. These symptoms are indicative of a possible foreign body in the airway, which can lead to serious complications and requires immediate attention to ensure the toddler's airway remains patent and unobstructed.

5. A clinic nurse reviews the record of a child just seen by a doctor and diagnosed with suspected aortic stenosis. The nurse expects to note documentation of which clinical manifestation specifically found in this disorder?

• A. Pallor
• B. Hyperactivity
• C. Exercise intolerance
• D. Gastrointestinal disturbances

Correct answer: C

Rationale: Aortic stenosis is a condition characterized by the narrowing of the aortic valve, leading to reduced blood flow from the heart to the body. This narrowing restricts the amount of oxygenated blood that can reach various tissues, including muscles. As a result, individuals with aortic stenosis may experience exercise intolerance, as their muscles may not receive an adequate oxygen supply during physical activity. This can manifest as fatigue, shortness of breath, and overall decreased exercise capacity. Pallor (choice A) is a pale appearance that may be seen in anemia or other conditions affecting blood flow but is not specific to aortic stenosis. Hyperactivity (choice B) and gastrointestinal disturbances (choice D) are not typically associated with aortic stenosis.

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