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Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?
- A. Allow formula to flow by gravity.
- B. Insert tube through nares rather than mouth.
- C. Avoid letting newborn suck on tube.
- D. Apply steady pressure to syringe to deliver formula to stomach in a timely manner.
Correct Answer: C
Rationale: The most appropriate nursing action when intermittently gavage-feeding a preterm newborn is to avoid letting the newborn suck on the tube. Preterm infants are at risk for disorganized feeding patterns and can develop a non-nutritive sucking habit when the tube is in their mouth. Allowing them to suck on the tube can lead to difficulty transitioning to oral feeding once they are ready, as they may associate feeding with the tube rather than with proper suckling at the breast or bottle. Therefore, it is important to prevent non-nutritive sucking during gavage feedings to promote successful oral feeding later on.
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A nurse notes that a 12-hour-old newborn has not had the first meconium stool. The nurse documents this finding and continues to monitor the newborn because, in term newborns, the first meconium stool occurs within how many hours of birth?
- A. 6 to 8
- B. 8 to 12
- C. 12 to 24
- D. 24 to 48
Correct Answer: A
Rationale: In term newborns, the first meconium stool typically occurs within the first 6 to 8 hours after birth. Meconium is the baby's first stool, and its presence signifies that the baby's gastrointestinal system is functioning properly. If a newborn has not passed meconium within this timeframe, it may indicate an issue such as bowel obstruction that requires further evaluation and intervention. Therefore, the nurse should document and monitor the situation closely to ensure the newborn's health and well-being.
The nurse is admitting a school-age child in acute renal failure with reduced glomerular filtration rate. Which urine test is the most useful clinical indication of glomerular filtration rate?
- A. pH
- B. Osmolality
- C. Creatinine
- D. Protein level
Correct Answer: C
Rationale: Creatinine is a waste product produced by muscle metabolism that is normally filtered by the glomerulus in the kidneys and excreted in urine. The level of creatinine in the urine is a direct reflection of the glomerular filtration rate (GFR). As GFR decreases in conditions such as acute renal failure, the amount of creatinine excreted in the urine also decreases. Therefore, measuring creatinine levels in the urine is a useful clinical indication of the glomerular filtration rate and kidney function. pH, osmolality, and protein level may provide additional information but are not as directly linked to GFR as creatinine levels.
Chemotherapy has a major role in many childhood CNS tumors. In which of the following tumors is chemotherapy not effective?
- A. pilocytic astrocytoma
- B. craniopharyngioma
- C. pineoblastoma
- D. supratentorial primitive neuroectodermal tumors (SPNETs)
Correct Answer: A
Rationale: Pilocytic astrocytomas are generally low-grade and less responsive to chemotherapy compared to other listed tumors.
The physician prescribes glipizide (Glucotrol), an oral antidiabetic agent, for a client with type 2 diabetes mellitus who has been having trouble controlling the blood glucose level through diet and exercise. Which medication instruction should the nurse provide?
- A. "Be sure to take glipizide 30 minutes before meals."
- B. "Glipizide may cause a low serum sodium level, so make sure you have your sodium level checked monthly."
- C. "You won't need to check you blood glucose level after you start taking glipizide."
- D. "Take glipizide after a metal to prevent heartburn."
Correct Answer: A
Rationale: A. "Be sure to take glipizide 30 minutes before meals."
Osteosarcoma is the most common primary malignant bone tumor in children and adolescents; it has multiple subtypes and requires different modalities of treatment including surgery and chemotherapy. Of the following, the subtype of osteosarcoma which is treated by surgery alone is
- A. fibroblastic
- B. chondroblastic
- C. parosteal
- D. periosteal
Correct Answer: D
Rationale: Periosteal osteosarcoma is often treated with surgery alone if margins are clear.