Nokea
A nurse is making an initial postpartum home visit. Which of the following client statements should the nurse identity as a manifestation of Increased risk for child abuse?
- A. I want to meet other parents to see if they are going through the same things.
- B. I try to respond to the baby quickly so she doesn't cry very long.
- C. I think the baby should be sleeping through the night by now.
- D. I have several friends who come by to help out with the baby.
Correct Answer: C
Rationale: Expecting a newborn to sleep through the night is unrealistic and may indicate frustration or lack of understanding, which are risk factors for child abuse. Other statements reflect normal parental concerns or support systems.
You may also like to solve these questions
What is the recommended method of feeding for a full-term newborn who is not at risk for hypoglycemia?
- A. Breastfeeding
- B. Formula feeding
- C. Tube feeding
- D. All of the above
Correct Answer: A
Rationale: Breastfeeding is the recommended method of feeding for full-term newborns who are not at risk for hypoglycemia.
Which of the following is a potential complication of a breech delivery?
- A. Fetal distress
- B. Maternal hemorrhage
- C. Birth trauma
- D. All of the above
Correct Answer: C
Rationale: The correct answer is C: Birth trauma. In a breech delivery, where the baby is positioned feet or buttocks first, there is an increased risk of birth trauma due to potential difficulties in delivering the baby's head, leading to possible injuries such as fractures or nerve damage. Fetal distress and maternal hemorrhage can also occur but are not exclusive complications of breech delivery. Choice D, "All of the above," is incorrect as not all potential complications of a breech delivery are listed.
Which of the following is a potential complication of jaundice in a newborn?
- A. Kernicterus
- B. Hypoglycemia
- C. Respiratory distress
- D. Sepsis
Correct Answer: A
Rationale: The correct answer is A: Kernicterus. Kernicterus is a rare but serious complication of severe jaundice in newborns, where bilirubin levels become excessively high and cross the blood-brain barrier, leading to brain damage. Other choices are incorrect because: B) Hypoglycemia is not directly related to jaundice, C) Respiratory distress may occur but is not a direct complication of jaundice, and D) Sepsis is a separate condition from jaundice.
A nurse is providing teaching about immunizations to a client who is pregnant. Which of the following statements should the nurse include in the teaching?
- A. The immunization for varicella should be given at least 1 month prior to delivery.
- B. You can receive the rubella immunization during the third trimester of pregnancy.
- C. The hepatitis B immunization should not be obtained until after you finish breastfeeding.
- D. You can receive the immunization for influenza at any time during your pregnancy.
Correct Answer: D
Rationale: The influenza vaccine is safe and recommended during pregnancy to protect both the mother and the baby. Varicella and rubella vaccines are contraindicated during pregnancy.
A nurse is caring for a client who is 1 hr postpartum and has uterine atony. The client is exhibiting a large amount of vaginal bleeding. Which of the following actions should the nurse take?
- A. Administer betamethasone IM.
- B. Avoid performing sterile vaginal examinations.
- C. Anticipate a prescription for misoprostol.
- D. Obtain a specimen for a Kleihauer-Betke test.
Correct Answer: C
Rationale: The correct answer is C: Anticipate a prescription for misoprostol. Misoprostol is a medication used to help contract the uterus and control postpartum hemorrhage caused by uterine atony. It helps stimulate uterine contractions and reduce bleeding. Administering betamethasone (choice A) is not indicated for uterine atony and postpartum hemorrhage. Avoiding sterile vaginal examinations (choice B) does not address the underlying issue of uterine atony. Obtaining a specimen for a Kleihauer-Betke test (choice D) is used to assess the amount of fetal-maternal hemorrhage and is not an immediate intervention for uterine atony.