Nokea
A full-term neonate is admitted to the normal newborn nursery. The nurse notes a Moro reflex. What should the nurse do next?
- A. Call a code.
- B. Identify this reflex as a normal finding.
- C. Place the neonate on seizure precautions.
- D. Start supplemental oxygen.
Correct Answer: B
Rationale: The Moro reflex is a normal finding in full-term neonates, indicating a healthy neurological response.
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A client asks about the benefits of the copper IUD. Which of the following would the nurse include?
- A. It reduces menstrual bleeding.
- B. It is hormone-free and effective for up to 10 years.
- C. It requires daily monitoring.
- D. It prevents ovulation.
Correct Answer: B
Rationale: The copper IUD is hormone-free and effective for up to 10 years, offering long-term contraception. It may increase menstrual bleeding, does not require daily monitoring, and does not prevent ovulation.
While assessing the fundus of a multiparous client 36 hours after delivery of a term neonate, the nurse notes a separation of the abdominal muscles. What action should the nurse take based on this assessment?
- A. Notify the health care provider of the separation.
- B. Discuss with the client that no further action is needed.
- C. Demonstrate exercises involving head and shoulder lifting.
- D. Refer the client to a surgeon for surgical repair after 6 weeks postpartum.
Correct Answer: C
Rationale: Diastasis recti is managed with specific exercises like head and shoulder lifts to strengthen abdominal muscles.
Three days after admission of a neonate delivered at 30 weeks' gestation, the neonatologist plans to assess the neonate for periventricular-intraventricular hemorrhage (PIVH). The nurse should plan to assist the neonatologist by preparing the neonate for which of the following?
- A. Computed tomography scan.
- B. Arterial blood specimen collection.
- C. Radiographs of the skull.
- D. Complete blood count specimen collection.
Correct Answer: A
Rationale: A computed tomography scan is used to assess for PIVH, as it visualizes bleeding in the brain.
At 38 weeks' gestation, a primigravid client with poorly controlled diabetes and severe preeclampsia is admitted for a cesarean delivery. The nurse explains to the client that delivery helps to prevent which of the following?
- A. Neonatal hyperbilirubinemia.
- B. Congenital anomalies.
- C. Perinatal asphyxia.
- D. Stillbirth.
Correct Answer: D
Rationale: Delivery helps prevent stillbirth in high-risk pregnancies.
A primigravid client with insulin-dependent diabetes tells the nurse that the contraction stress test performed earlier in the day was suspicious. The nurse interprets this test result as indicating that the fetal heart rate pattern showed which of the following?
- A. Frequent late decelerations.
- B. Decreased fetal movement.
- C. Inconsistent late decelerations.
- D. Lack of fetal movement.
Correct Answer: C
Rationale: Suspicious results indicate inconsistent late decelerations.