Nokea
A nurse is assessing a client following an amniocentesis. Which of the following findings should the nurse recognize as complications? (Select all that apply).
- A. Amnionitis
- B. Urinary tract infection
- C. Polyhydramnios
- D. Leakage of amniotic fluid
Correct Answer: A
Rationale: A. Amnionitis: This is the inflammation of the amniotic sac or membranes and is a potential complication following an amniocentesis procedure. It can lead to maternal fever, fetal tachycardia, and other signs of infection.
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A public health nurse visits the home of a young toddler. What aspect of the home environment would the nurse expect to address with the parents?
- A. The presence of power cords plugged into capped outlets
- B. Cartoons playing on a television in the child's room
- C. The family dog is present in the house during the visit
- D. The presence of pots on the stove with handles pointing toward back
Correct Answer: B
Rationale: The nurse is encouraged to ask questions regarding the amount of recreational screen time and if the child has a television or Internet-connected device in his or her bedroom. The American Academy of Pediatrics discourages any screen media before the age of 2.
On admission to the nursery, a newborn is observed to be experiencing cold stress. The basis for the nursing intervention at this time would be to minimize:
- A. Shivering
- B. Hyperglycemia
- C. Oxygen consumption
- D. Metabolism of fat stores
Correct Answer: A
Rationale: Shivering increases oxygen demand.
What advice should the nurse give a woman taking Fosamax (alendronate) for osteoporosis?
- A. Remain upright for 30 minutes after taking the medication.
- B. Take only after eating a full meal.
- C. Take medication in divided doses 3 times each day.
- D. Do not break or crush the tablet.
Correct Answer: A
Rationale: Remaining upright prevents esophageal irritation.
Most newborns receive a prophylactic injection of vitamin K soon after birth. Which site is appropriate for the newborn?
- A. Gluteal muscles
- B. Rectus femoris muscle
- C. Deltoid muscle
- D. Vastus lateralis muscle
Correct Answer: D
Rationale: Vastus lateralis muscle is the recommended site due to its size and safety.
What findings would make the nurse suspicious of anorexia in a client?
- A. Aversion to exercise and food allergies.
- B. Significant weight loss and amenorrhea.
- C. Respiratory distress and thick oral mucus.
- D. Cardiac arrhythmias and anasarca.
Correct Answer: B
Rationale: Weight loss and amenorrhea are hallmark signs of anorexia.