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A nurse is teaching the staff about the Institute of Medicine competencies. Which examples indicate the staff has a correct understanding of the teaching? (Select all that apply.)
- A. Use informatics.
- B. Use transparency.
- C. Apply globalization.
- D. Apply quality improvement.
Correct Answer: D
Rationale: The Institute of Medicine competencies include: Provide patient-centered care; work in interdisciplinary teams; use evidence-based practice; apply quality improvement; and use informatics. Transparency is included in the 10 rules of performance in a redesigned health care system, not a competency. While globalization is important in health care, it is not a competency.
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A nurse notes that a baby is lying in a crib in the tonic neck position. In which of the following positions is the baby lying?
- A. One of the baby's arms and one of its legs are extended to the same side the baby's head is facing.
- B. When the baby faces straight ahead, the baby's head tilts toward one side.
- C. Both the baby's back and head are sharply arched backward and resist being moved to midline.
- D. When the baby lies prone, the baby's body arches to one side.
Correct Answer: A
Rationale: The tonic neck reflex, or fencer's position, involves the baby's arm and leg on one side extending while the opposite arm and leg flex.
A mother questions the nurse about when the newborn screening tests for inborn diseases will be performed. Which of the following is an appropriate response by the nurse?
- A. The doctor took blood from the baby's umbilical cord at birth.
- B. A sample of the baby's first urine and first stool were sent for testing.
- C. A vial of blood was drawn and sent when the baby was admitted to the nursery.
- D. Blood from the baby's heel was sent after the baby had been fed a few times.
Correct Answer: D
Rationale: Newborn screening tests are typically done by collecting blood from the baby's heel after the baby has been fed a few times to ensure accurate results.
A nurse is teaching the staff about managed care. Which information should the nurse include in the teaching session?
- A. Managed care insures full coverage of health care costs.
- B. Managed care only assumes the financial risk involved.
- C. Managed care allows providers to focus on illness care.
- D. Managed care causes providers to focus on prevention.
Correct Answer: D
Rationale: Managed care describes health care systems in which the provider or the health care system receives a predetermined capitated (fixed amount) payment for each patient enrolled in the program. Therefore, the focus of care shifts from individual illness care to prevention, early intervention, and outpatient care.
The nurse is caring for a client who had a contraction stress test. Which change in assessment requires immediate notification of the health care provider?
- A. No late decelerations
- B. Late decelerations with at least 50% of the contractions
- C. Accelerations with contractions
- D. No contractions produced
Correct Answer: B
Rationale: The correct answer is B because late decelerations with at least 50% of contractions indicate fetal distress and potential hypoxia. This requires immediate notification of the healthcare provider for further evaluation and intervention. No late decelerations (choice A) are normal. Accelerations with contractions (choice C) are reassuring. No contractions produced (choice D) would indicate an inadequate test and require reevaluation.
On the third postpartum day a client tells the nurse that she feels sad and that she cries easily. The nurse should explain about which of the following?
- A. These feelings are normal and should diminish when the baby is a week or so old.
- B. The physician will likely order an antidepressant for the client to take at home.
- C. If the client focuses on the fact that she has a healthy baby, the feelings will cease.
- D. When the client is home with her family and friends, her sad feelings will disappear.
Correct Answer: A
Rationale: Postpartum blues are common and usually resolve within a week or two. Persistent sadness may indicate postpartum depression, but initial feelings are normal.