Nokea
A nurse is caring for a newborn who is 12 hr old and is experiencing jitteriness. Which of the following laboratory findings should the nurse identify as the priority?
- A. Blood glucose
- B. Total bilirubin
- C. Hemoglobin
- D. Blood calcium
Correct Answer: A
Rationale: The correct answer is A: Blood glucose. In a newborn experiencing jitteriness, the priority is to assess blood glucose levels to rule out hypoglycemia. Newborns are at risk for hypoglycemia due to limited glycogen stores and high metabolic demands. Untreated hypoglycemia can lead to serious complications like seizures and brain damage. Total bilirubin (choice B) is important for assessing jaundice but is not the priority in this case. Hemoglobin (choice C) and blood calcium (choice D) are not typically the first considerations for jitteriness in a newborn.
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A school nurse is providing teaching to an adolescent about levonorgestrel contraception. Which of the following information should the nurse include in the teaching?
- A. You should take the medication within 72 hours following unprotected sexual intercourse.
- B. You should avoid taking this medication if you are on an oral contraceptive.
- C. If you don't start your period within 5 days of taking this medication, you will need a pregnancy test.
- D. One dose of this medication will prevent you from becoming pregnant for 14 days after taking it.
Correct Answer: A
Rationale: Levonorgestrel is an emergency contraceptive that should be taken within 72 hours of unprotected intercourse to be most effective in preventing pregnancy.
A nurse is providing teaching to the parents of a newborn about newborn genetic screening. Which of the following statements should the nurse Include in the teaching?
- A. This test will be repeated when your baby is 2 months old.
- B. A nurse will draw blood from your baby's inner elbow.
- C. This test should be performed after your baby is 24 hours old.
- D. Your baby will be given 2 ounces of water to drink prior to the test.
Correct Answer: C
Rationale: Newborn genetic screening is typically performed after 24 hours of birth to ensure accurate results and allow time for metabolic processes to stabilize.
A nurse is planning care for a client who is to undergo a nonstress test. Which of the following actions should the nurse include in the plan of care?
- A. Maintain the client NPO throughout the procedure.
- B. Place the client in a supine position.
- C. Instruct the client to massage the abdomen to stimulate fetal movement.
- D. Instruct the client to press the provided button each time fetal movement is detected.
Correct Answer: D
Rationale: The correct answer is D: Instruct the client to press the provided button each time fetal movement is detected. During a nonstress test, the client is monitored for fetal heart rate accelerations in response to fetal movement. Instructing the client to press the button each time fetal movement is detected helps correlate fetal heart rate changes with fetal activity. This is crucial in assessing the well-being of the fetus.
A, B, and C are incorrect choices because maintaining the client NPO, placing the client in a supine position, and instructing the client to massage the abdomen are not relevant or necessary for a nonstress test. Option D is the best choice as it directly assists in monitoring fetal well-being during the test.
A nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 min. The nurse should identify which of the following conditions as a possible cause of fetal bradycardia?
- A. Maternal hypoglycemia
- B. Chorioamnionitis
- C. Fetal anemia
- D. Maternal fever
Correct Answer: C
Rationale: Fetal anemia can lead to bradycardia due to reduced oxygen delivery to the fetal heart.
Which of the following is a potential barrier to patient safety in maternal and newborn healthcare?
- A. Medication errors
- B. Inadequate staffing
- C. Patient noncompliance
- D. All of the above
Correct Answer: D
Rationale: Barriers to patient safety include medication errors, inadequate staffing, and patient noncompliance.