Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A newborn is suspected of having esophageal atresia with tracheoesophageal fistula (TEF). Which clinical finding would most strongly support this diagnosis?
A. Excessive oral secretions, coughing, and cyanosis during feeding
Excessive oral secretions, coughing, and cyanosis during feeding is correct. These are classic signs of esophageal atresia with tracheoesophageal fistula (TEF). TEF results in an abnormal connection between the trachea and esophagus, causing ingested fluids to enter the airway. This leads to choking, coughing, cyanosis, and excessive drooling, especially during feeding. Early recognition is critical to prevent aspiration and respiratory complications.
B. Poor suck reflex and hypotonia
Poor suck reflex and hypotonia is incorrect because these findings are associated with neurologic or metabolic disorders, not TEF. While feeding difficulties may occur, they do not specifically indicate a fistula between the trachea and esophagus.
C. Projectile vomiting with blood-tinged emesis
Projectile vomiting with blood-tinged emesis is incorrect because this is more characteristic of pyloric stenosis or upper gastrointestinal bleeding, not TEF. TEF primarily affects swallowing and airway protection, not gastric emptying.
D. Bilious vomiting with abdominal distension
Bilious vomiting with abdominal distension is incorrect because these signs suggest intestinal obstruction, such as malrotation or intestinal atresia, rather than TEF.
This question is an excerpt from Nurse Dive's nursing test bank - Ati dmmsn 650 OB/Pediatrics Proctored Exams. Take the full exam now
Full Explanation
A. Excessive oral secretions, coughing, and cyanosis during feeding is correct. These are classic signs of esophageal atresia with tracheoesophageal fistula (TEF). TEF results in an abnormal connection between the trachea and esophagus, causing ingested fluids to enter the airway. This leads to choking, coughing, cyanosis, and excessive drooling, especially during feeding. Early recognition is critical to prevent aspiration and respiratory complications.
B. Poor suck reflex and hypotonia is incorrect because these findings are associated with neurologic or metabolic disorders, not TEF. While feeding difficulties may occur, they do not specifically indicate a fistula between the trachea and esophagus.
C. Projectile vomiting with blood-tinged emesis is incorrect because this is more characteristic of pyloric stenosis or upper gastrointestinal bleeding, not TEF. TEF primarily affects swallowing and airway protection, not gastric emptying.
D. Bilious vomiting with abdominal distension is incorrect because these signs suggest intestinal obstruction, such as malrotation or intestinal atresia, rather than TEF.
Similar Questions
A 24-year-old pregnant woman asks the nurse if it is safe to drink alcohol during pregnancy. Which of the following is the most appropriate response?
A. Small amounts of alcohol are safe during the second trimester."
"Small amounts of alcohol are safe during the second trimester." is incorrect because no amount of alcohol is considered safe during pregnancy. Even small amounts can affect fetal development and increase the risk of fetal alcohol spectrum disorders (FASD).
B. "Alcohol is only harmful in the first trimester."
"Alcohol is only harmful in the first trimester." is incorrect because alcohol exposure can be harmful at any stage of pregnancy, not just the first trimester. While organogenesis occurs early, alcohol can still affect fetal growth, brain development, and neurobehavioral outcomes throughout pregnancy.
C. "Alcohol should be avoided completely during pregnancy."
"Alcohol should be avoided completely during pregnancy." is correct. The safest recommendation is complete abstinence from alcohol. This approach eliminates the risk of alcohol-related complications and supports optimal fetal development. Health authorities, including the CDC and ACOG, advise that no level of alcohol is safe during pregnancy.
D. "Beer is safer than hard liquor while pregnant."
"Beer is safer than hard liquor while pregnant." is incorrect because all types of alcoholic beverages pose a risk to the developing fetus, regardless of alcohol content or type. There is no safe form of alcohol during pregnancy.
Full Explanation
A. "Small amounts of alcohol are safe during the second trimester." is incorrect because no amount of alcohol is considered safe during pregnancy. Even small amounts can affect fetal development and increase the risk of fetal alcohol spectrum disorders (FASD).
B. "Alcohol is only harmful in the first trimester." is incorrect because alcohol exposure can be harmful at any stage of pregnancy, not just the first trimester. While organogenesis occurs early, alcohol can still affect fetal growth, brain development, and neurobehavioral outcomes throughout pregnancy.
C. "Alcohol should be avoided completely during pregnancy." is correct. The safest recommendation is complete abstinence from alcohol. This approach eliminates the risk of alcohol-related complications and supports optimal fetal development. Health authorities, including the CDC and ACOG, advise that no level of alcohol is safe during pregnancy.
D. "Beer is safer than hard liquor while pregnant." is incorrect because all types of alcoholic beverages pose a risk to the developing fetus, regardless of alcohol content or type. There is no safe form of alcohol during pregnancy.
A nurse is assisting with the delivery of a newborn when the head is delivered, but the shoulders become stuck behind the maternal pubic bone. Which of the following is the nurse's priority action?
A. Pull the baby out forcefully by the head with forceps
Pull the baby out forcefully by the head with forceps is incorrect because forceful traction can cause severe injury to the baby, including brachial plexus injury, clavicle fracture, or intracranial hemorrhage. This is not recommended for shoulder dystocia.
B. Apply gentle upward traction on the baby's head
Apply gentle upward traction on the baby's head is incorrect because while gentle traction is part of standard delivery, upward traction alone is usually insufficient to resolve shoulder dystocia and may risk injury if used improperly.
C. Wait for the mother to push the shoulders out naturally
Wait for the mother to push the shoulders out naturally is incorrect because shoulder dystocia is an obstetric emergency. Delaying intervention can lead to hypoxia, birth asphyxia, or fetal injury, so immediate maneuvers are required.
D. Place the mother in McRoberts maneuver position and apply suprapubic pressure
Place the mother in McRoberts maneuver position and apply suprapubic pressure is correct. The McRoberts maneuver involves flexing the mother’s hips tightly toward her abdomen, which flattens the sacral promontory and increases the pelvic diameter. Simultaneously, suprapubic pressure helps dislodge the impacted anterior shoulder. This is the first-line, evidence-based intervention for shoulder dystocia and reduces the risk of fetal and maternal complications.
Full Explanation
A. Pull the baby out forcefully by the head with forceps is incorrect because forceful traction can cause severe injury to the baby, including brachial plexus injury, clavicle fracture, or intracranial hemorrhage. This is not recommended for shoulder dystocia.
B. Apply gentle upward traction on the baby's head is incorrect because while gentle traction is part of standard delivery, upward traction alone is usually insufficient to resolve shoulder dystocia and may risk injury if used improperly.
C. Wait for the mother to push the shoulders out naturally is incorrect because shoulder dystocia is an obstetric emergency. Delaying intervention can lead to hypoxia, birth asphyxia, or fetal injury, so immediate maneuvers are required.
D. Place the mother in McRoberts maneuver position and apply suprapubic pressure is correct. The McRoberts maneuver involves flexing the mother’s hips tightly toward her abdomen, which flattens the sacral promontory and increases the pelvic diameter. Simultaneously, suprapubic pressure helps dislodge the impacted anterior shoulder. This is the first-line, evidence-based intervention for shoulder dystocia and reduces the risk of fetal and maternal complications.
A 3-year-old child is diagnosed with neuroblastoma after presenting with a mass in the abdomen, abnormal eye movements, and swelling of the face. Which of the following is the most common site of origin for neuroblastoma in children?
A. Liver
Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain.
B. Brain
Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies.
C. Kidneys
Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children.
D. Adrenal glands
Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.
Full Explanation
A. Liver is incorrect because the liver is not the primary site of neuroblastoma. While the liver can become involved through metastasis, the tumor originates elsewhere along the sympathetic chain.
B. Brain is incorrect because neuroblastoma develops from peripheral sympathetic tissue, not the central nervous system. Brain tumors in children are a separate category of malignancies.
C. Kidneys is incorrect. Although neuroblastoma can present as an abdominal mass that seems near the kidneys, the tumor originates from the adrenal glands, not the renal tissue itself. Wilms’ tumor, not neuroblastoma, arises from the kidneys in children.
D. Adrenal glands is correct. Approximately 40% of neuroblastomas originate in the adrenal medulla, located above the kidneys. Other tumors may arise along the sympathetic chain, including the chest, neck, and pelvis. The adrenal origin explains why children may present with abdominal masses, abdominal pain, or systemic symptoms. Metastatic spread can cause periorbital ecchymosis (“raccoon eyes”), proptosis, and facial edema, as seen in this child, reflecting tumor spread to orbital bones and lymphatic structures.