Nokea
A 27-week gestation infant is taken to a newborn intensive care unit 150 miles away. Initially, which emotion should the nurse expect the mother to display after the transfer?
- A. Denial
- B. Frustration
- C. Guilt
- D. Anger
Correct Answer: C
Rationale: The correct answer is C: Guilt. The mother may feel responsible for the premature birth and subsequent transfer, leading to feelings of guilt. This is a common emotional response in such situations. Denial (A), frustration (B), and anger (D) may also be present, but guilt is the most likely initial emotion due to the perceived connection between the mother and the baby's health.
You may also like to solve these questions
A nurse is checking children at an orthopedic outpatient setting. Which of the following should the nurse expect to see as manifestations of scoliosis?
- A. Pain and an exaggerated lumbar curvature'
- B. Uneven shoulder heights and poorly fitting slacks'
- C. Tenderness and swelling of the spine'
- D. Limited range of motion of the back and a limp'
Correct Answer: B
Rationale: The correct answer is B. Uneven shoulder heights and poorly fitting slacks are common manifestations of scoliosis because the condition causes an abnormal curvature of the spine, leading to uneven shoulders and hips. Pain and exaggerated lumbar curvature (choice A) are not specific manifestations of scoliosis. Tenderness and swelling of the spine (choice C) could indicate other conditions like infection or inflammation, not necessarily scoliosis. Limited range of motion of the back and a limp (choice D) are more indicative of musculoskeletal injuries or disorders, not scoliosis.
A nurse is initiating a plan of care for a toddler who is hospitalized. Which of the following instructions is important to communicate to the nursing assistant?
- A. Have the toddler dress himself.
- B. Offer the toddler finger foods for snacks.
- C. Provide opportunities to share toys with others.
- D. Ask the child simple yes or no questions.
Correct Answer: B
Rationale: The correct answer is B: Offer the toddler finger foods for snacks. This instruction is important to communicate to the nursing assistant because toddlers are at risk for choking on certain foods due to their developing chewing and swallowing abilities. Finger foods are safer for toddlers to eat as they are easier to manage and reduce the risk of choking.
Other choices are incorrect because:
A: Having the toddler dress himself may not be appropriate as toddlers may need assistance and supervision due to their limited motor skills.
C: Providing opportunities to share toys with others is important for social development but is not as critical as ensuring the toddler's safety during meal times.
D: Asking the child simple yes or no questions is a good communication strategy but not as essential for the toddler's safety during snack times.
In which position should the nurse place the laboring client in order to increase the intensity of the contractions and improve oxygenation to the fetus?
- A. Supine with legs elevated
- B. Squatting
- C. Left side-lying
- D. High Fowler's
Correct Answer: C
Rationale: The correct answer is C, left side-lying position. This position promotes optimal blood flow to the placenta, enhancing oxygenation to the fetus. It also helps prevent compression of the vena cava, ensuring adequate circulation to the mother. Supine position with legs elevated (A) can compress the vena cava, reducing blood flow to the fetus. Squatting (B) may not improve oxygenation to the fetus and can be tiring for the laboring client. High Fowler's position (D) can impede blood flow to the placenta due to compression of abdominal vessels.
Which physiological change takes place during the puerperium?
- A. The endometrium begins to undergo alterations necessary for menstruation.
- B. The placenta begins to separate from the uterine wall.
- C. The uterus returns to a pre-pregnant size and location.
- D. The uterus contracts at regular intervals with dilation of the cervix occurring.
Correct Answer: C
Rationale: During the puerperium, the correct physiological change is that the uterus returns to a pre-pregnant size and location (Choice C). This is because after childbirth, the uterus undergoes involution, gradually decreasing in size back to its pre-pregnant state. This process involves the shedding of excess tissue and contraction of uterine muscles. The endometrium (Choice A) does not undergo alterations for menstruation until after the puerperium, as menstruation typically resumes around 6-8 weeks postpartum. The placenta (Choice B) should have been expelled completely during the third stage of labor, so it does not separate during the puerperium. The uterus does contract, but it is not at regular intervals with cervical dilation (Choice D) during the puerperium.
A nurse on a pediatric unit is assigned to care for a child with Reye syndrome. Which of the following is the most serious clinical manifestation for which the nurse should monitor?
- A. Anaphylaxis
- B. Cerebral edema
- C. Impaired coagulation
- D. Hypervolemia
Correct Answer: B
Rationale: The correct answer is B: Cerebral edema. In Reye syndrome, cerebral edema is the most serious manifestation due to increased intracranial pressure, potentially leading to brain damage or death. Anaphylaxis (A) is not typically associated with Reye syndrome. Impaired coagulation (C) can occur but is not as immediately life-threatening as cerebral edema. Hypervolemia (D) is a possible complication but not as critical as cerebral edema in Reye syndrome.