Nokea
A new mother tells the nurse that she is getting a new microwave so that her husband can help prepare the baby's feedings. The nurse should:
- A. Explain that a microwave should never be used to warm the baby's bottles.
- B. Tell the mother that microwaving is the best way to prevent bacteria in the formula.
- C. Tell the mother to shake the bottle vigorously for one minute after warming in the microwave.
- D. Instruct the parents to always leave the top of the bottle open while microwaving so heat can escape.
Correct Answer: A
Rationale: Microwaving baby bottles can cause uneven heating, leading to burns, so it should be avoided; warming under running water or in a bottle warmer is safer.
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An adolescent client with cystic acne has a prescription for Accutane (isotretinoin). Which lab work is needed before beginning the medication?
- A. Complete blood count
- B. Clean-catch urinalysis
- C. Liver profile
- D. Thyroid function test
Correct Answer: C
Rationale: Isotretinoin can cause liver toxicity, requiring a baseline liver profile to monitor for elevations in liver enzymes. CBC, urinalysis, and thyroid tests are not primary concerns.
A client has received digoxin 0.25 mg po daily for 2 weeks. Which of the following digoxin levels indicates toxicity?
- A. 0.5 ng/mL
- B. 1.0 ng/mL
- C. 2.0 ng/mL
- D. 3.0 ng/mL
Correct Answer: D
Rationale: Digoxin's therapeutic level is 0.8-2.0 ng/mL. Digoxin's toxic level is >2.0 ng/mL.
A client is admitted to the labor room. She is dilated 4 cm. She is placed on electric fetal monitoring. Which of the following observations necessitates notifying the physician?
- A. Contractions every 2 minutes, lasting 100 seconds
- B. Fetal heart decelerations during a contraction
- C. Beat-to-beat variability between contractions
- D. Fetal heart decelerations at the beginning of contractions
Correct Answer: A
Rationale: These are tetanic in nature and can cause rupture of the uterus. The FHR decreases during contractions owing to vasoconstriction and should recover after the contraction. Beat-to-beat variability is a normal finding and demonstrates fetal well-being. The FHR may decrease at the beginning of a contraction owing to head compression.
The nurse is preparing to administer a feeding via a nasogastric tube. The nurse would perform which of the following before initiating the feeding?
- A. Assess for tube placement by aspirating stomach content.
- B. Place the patient in a left-lying position.
- C. Administer feeding with 50% Dextrose.
- D. Ensure that the feeding solution has been warmed in a microwave for two minutes.
Correct Answer: A
Rationale: Verifying nasogastric tube placement by aspirating stomach contents (and checking pH) is critical to prevent aspiration. Left-lying position is incorrect, 50% dextrose is inappropriate, and microwaving can cause burns or nutrient degradation.
The client is admitted with a diagnosis of placenta accreta. Which complication is most likely to occur?
- A. Maternal hemorrhage
- B. Fetal distress
- C. Preterm labor
- D. All of the above
Correct Answer: D
Rationale: Placenta accreta where the placenta abnormally adheres to the uterine wall increases the risk of maternal hemorrhage (during delivery) fetal distress (from placental dysfunction) and preterm labor (from interventions). All are potential complications.