Nokea
A newborn weighed 7 pounds at birth. At 6 months of age, the infant could be expected to weigh:
- A. 14 pounds
- B. 18 pounds
- C. 25 pounds
- D. 30 pounds
Correct Answer: A
Rationale: Infants typically double their birth weight by 6 months, so a 7-pound newborn would weigh approximately 14 pounds.
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An obstetric client is admitted with dehydration. Which IV fluid would be most appropriate for the client?
- A. .45 normal saline
- B. Dextrose 1% in water
- C. Lactated Ringer's
- D. Dextrose 5% in .45 normal saline
Correct Answer: C
Rationale: Lactated Ringer's is isotonic and effective for correcting dehydration in obstetric clients, replacing fluids and electrolytes.
The nurse is caring for a client who is 14 weeks pregnant. The client is asking about vaccinations that can be given during pregnancy. Which of the following vaccines does the nurse tell the client that are safe during pregnancy?
- A. mumps
- B. measles
- C. smallpox
- D. influenza
Correct Answer: D
Rationale: The influenza vaccine is safe and recommended during pregnancy. Mumps, measles, and smallpox vaccines are contraindicated.
To ensure safety while administering a nitroglycerine patch, the nurse should:
- A. Wear gloves while applying the patch.
- B. Shave the area where the patch will be applied.
- C. Wash the area thoroughly with soap and rinse with hot water.
- D. Apply the patch to the buttocks.
Correct Answer: A
Rationale: Gloves prevent the nurse from absorbing nitroglycerin, avoiding side effects.
Before administering a client's morning dose of Lanoxin (digoxin), the nurse checks the apical pulse rate and finds a rate of 54. The appropriate nursing intervention is to:
- A. Record the pulse rate and administer the medication
- B. Administer the medication and monitor the heart rate
- C. Withhold the medication and notify the doctor
- D. Withhold the medication until the heart rate increases
Correct Answer: C
Rationale: A pulse rate below 60 bpm is a contraindication for digoxin administration due to the risk of worsening bradycardia, so the nurse should withhold the dose and notify the physician.
The nurse is doing bowel and bladder retraining for the client with paraplegia. Which of the following is not a factor for the nurse to consider?
- A. Diet pattern
- B. Mobility
- C. Fluid intake
- D. Sexual function
Correct Answer: D
Rationale: Sexual function is not directly related to bowel and bladder retraining, unlike diet, mobility, and fluid intake.