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 is 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: The correct answer is D: Staff members who take care of your baby will be wearing a photo identification badge. This statement promotes the security and safety of the newborn by ensuring that only authorized personnel are handling the baby. It helps prevent unauthorized individuals from gaining access to the newborn. This practice aligns with hospital security protocols and minimizes the risk of infant abduction or mix-ups.
Choice A is incorrect as it goes against current safety practices of not carrying newborns to the nursery by non-parents for security reasons. Choice B is unrelated to the security and safety of the newborn. Choice C is incorrect as it goes against safe sleep guidelines which recommend placing the baby in a separate sleep area to reduce the risk of Sudden Infant Death Syndrome (SIDS).
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A nurse is preparing to perform Leopold maneuvers for a client. Identify the sequence the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
- A. Identify the attitude of the head.
- B. Palpate the fundus to identify the fetal part.
- C. Determine the location of the fetal back.
- D. Palpate for the fetal part presenting at the inlet.
Correct Answer: B, C, D, A
Rationale: The correct order for performing Leopold maneuvers is B, C, D, A. Firstly, palpating the fundus (B) helps determine the fetal part. Next, determining the location of the fetal back (C) guides the nurse to find the fetal back. Palpating for the fetal part at the inlet (D) helps identify its presentation. Lastly, identifying the attitude of the head (A) completes the assessment. Other choices are not relevant to the sequential assessment in Leopold maneuvers.
complete the following sentence by using the lists of options. The client is at highest risk for developing ---evidenced by the client's ---
- A. Endometritis.
- B. Mastitis.
- C. Postpartum hemorrhage.
- D. Group B streptococcus positive status.
- E. Spontaneous vaginal delivery.
- F. Median episiotomy.
Correct Answer: A
Rationale: Correct Answer: A
Rationale:
1. Endometritis is an infection of the uterine lining, commonly occurring post-delivery.
2. The client's risk for endometritis increases due to factors like prolonged labor, multiple vaginal exams, and retained placental fragments.
3. The client's condition or symptoms may include fever, uterine tenderness, foul-smelling lochia.
4. The other options (B-F) are not directly related to the highest risk for developing endometritis post-delivery.
A nurse is assessing a newborn following a circumcision. Which of the following findings should the nurse identify as an indication that the newborn is experiencing pain?
- A. Decreased heart rate.
- B. Chin quivering.
- C. Pinpoint pupils.
- D. Slowed respirations.
Correct Answer: B
Rationale: The correct answer is B: Chin quivering. Pain assessment in newborns can be challenging due to their limited ability to communicate. Chin quivering is a common behavioral indicator of pain in newborns. It is a subtle sign of distress and discomfort. Other choices such as decreased heart rate (A), pinpoint pupils (C), and slowed respirations (D) are not reliable indicators of pain in newborns. Decreased heart rate can indicate relaxation, pinpoint pupils are more indicative of opioid use, and slowed respirations might be a sign of sleepiness or relaxation rather than pain.
A nurse is assessing a newborn who is 16 hr old. Which of the following findings should the nurse report to the provider?
- A. Substernal retractions.
- B. Acrocyanosis.
- C. Overlapping suture lines.
- D. Head circumference 33 cm (13 in).
Correct Answer: A
Rationale: The correct answer is A: Substernal retractions. Substernal retractions indicate respiratory distress in a newborn, which can be a serious issue requiring immediate medical attention. Acrocyanosis (choice B) is a common finding in newborns and is not concerning. Overlapping suture lines (choice C) can be normal in newborns and typically resolve on their own. A head circumference of 33 cm (13 in) (choice D) is within the normal range for a newborn.
The nurse suspects the adolescent is experiencing pelvic inflammatory disease and is planning care. Which of the following prescriptions should the nurse expect the provider to prescribe? Drag words from the choices below to fill in each blank in the following sentence. The nurse should anticipate a provider's prescription for---------------------- and ------------------
- A. doxycydline
- B. acyclovir
- C. imiquimod
- D. fluconazole
- E. ceftriaxone
- F. Providing education on medications
Correct Answer: A,E,F
Rationale: The correct answer is A, E, and F. Pelvic inflammatory disease is commonly caused by sexually transmitted infections, such as Chlamydia and Gonorrhea. The recommended treatment involves antibiotics like doxycycline (A) and ceftriaxone (E) to target these infections. Providing education on medications (F) is essential to ensure compliance and understanding of the treatment regimen. Acyclovir (B) is used to treat herpes infections, not PID. Imiquimod (C) is used for certain skin conditions, not PID. Fluconazole (D) is an antifungal medication, not typically used for PID treatment.