Nokea
A nurse is teaching a postpartum client about steps the nurses will take to promote the security and safety of the client's newborn. Which of the following statements should the nurse make?
- A. "The nurse will carry your baby in their arms to the nursery for scheduled procedures."
- B. "We will document the relationship of visitors in your medical record."
- C. "It's okay for your baby to sleep in the bed with you while in the hospital."
- D. "Staff members who take care of your baby will be wearing a photo identification badge."
Correct Answer: D
Rationale: Correct Answer: D
Rationale:
1. Staff wearing photo ID badges ensures proper identification for security.
2. Visual verification protects against unauthorized individuals caring for the baby.
3. ID badges indicate staff members have been vetted and authorized to care for newborns.
4. Promotes safety by ensuring only qualified individuals handle the baby.
Summary:
A: Carrying the baby to the nursery poses security risks and disrupts mother-infant bonding.
B: Documenting visitor relationships is important but does not directly address newborn security.
C: Co-sleeping with the baby in the hospital increases the risk of accidental suffocation.
D: Correct choice, as it directly addresses security and safety measures for the newborn.
E:
F:
G:
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A nurse is caring for a client who is in labor and notes that the umbilical cord is prolapsed. Which of the following actions should the nurse take?
- A. Evaluate uterine tone.
- B. Loosely wrap the cord with petroleum gauze.
- C. Apply fundal pressure.
- D. Place the client in Trendelenburg position
Correct Answer: D
Rationale: Placing the client in the Trendelenburg position helps reduce pressure on the prolapsed cord, preventing fetal distress. Other actions like applying fundal pressure or wrapping the cord are not appropriate.
Which stage of labor is characterized by the period between full cervical dilation and delivery of the fetus?
- A. First stage
- B. Second stage
- C. Third stage
- D. Fourth stage
Correct Answer: B
Rationale: The second stage of labor begins with full cervical dilation and ends with the delivery of the fetus.
A nurse is developing a plan of care for a newborn who is to undergo phototherapy for hyperbilirubinemia. Which of the following actions should the nurse include in the plan?
- A. Feed the newborn 1 oz of water every 4 hr.
- B. Apply lotion to the newborn’s skin three times per day.
- C. Remove all clothing from the newborn except the diaper.
- D. Discontinue therapy if the newborn develops a rash.
Correct Answer: C
Rationale: Removing all clothing except the diaper ensures maximum skin exposure to the phototherapy lights, which is essential for effective treatment of hyperbilirubinemia.
A nurse is caring for a newborn who has jaundice and a new prescription for phototherapy. Which of the following actions should the nurse take?
- A. Provide the newborn with 15 mL glucose water after each feeding.
- B. Turn the newborn every 4 hr.
- C. Apply hydrating lotion to the newborn’s skin prior to treatment.
- D. Close the newborn's eyes before applying eyepatches.
Correct Answer: D
Rationale: The correct answer is D: Close the newborn's eyes before applying eyepatches. To protect the newborn's eyes from potential damage due to phototherapy light, it is essential to close the eyes before placing eyepatches. This prevents exposure to the bright light, reducing the risk of eye irritation or injury. Providing glucose water (A), turning the newborn every 4 hours (B), and applying hydrating lotion (C) are not directly related to the phototherapy treatment for jaundice. Closing the eyes before applying eyepatches is crucial for the safety and comfort of the newborn during the phototherapy session.
What is the recommended method of administering erythromycin ointment to a newborn?
- A. Intramuscular injection
- B. Oral administration
- C. Topical application
- D. Subcutaneous injection
Correct Answer: C
Rationale: The correct answer is C: Topical application. Administering erythromycin ointment to a newborn involves applying it directly to the eyes to prevent neonatal conjunctivitis. This method ensures direct contact with the affected area, allowing for maximum effectiveness while minimizing systemic absorption and potential side effects. Intramuscular or subcutaneous injections are not appropriate for ointment administration, as they are meant for liquid medications. Oral administration would not target the eyes specifically. It is crucial to follow recommended guidelines to ensure the newborn's safety and effective treatment.