Nokea
A preterm neonate admitted to the neonatal intensive care unit at about 30 weeks' gestation is placed in an oxygenated isolette. The neonate's mother tells the nurse that she was planning to breast-feed the neonate. Which of the following instructions about breast-feeding would be most appropriate?
- A. Breast-feeding is not recommended because the neonate needs increased fat in the diet.
- B. Once the neonate no longer needs oxygen and continuous monitoring, breast-feeding can be done.
- C. Breast-feeding is contraindicated because the neonate is preterm.
- D. Gavage feedings using breast milk can be given until the neonate can coordinate sucking and swallowing.
Correct Answer: D
Rationale: Gavage feedings with breast milk allow the neonate to receive the benefits of breast milk while accommodating their immature sucking and swallowing reflexes.
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While assessing the episiotomy site of a primiparous client on the first postpartum day, the nurse observes a fairly large hemorrhoid at the client's rectum. After instructing the client about measures to relieve hemorrhoid discomfort, which of the following client statements indicates the need for additional teaching?
- A. I should try to gently manually replace the hemorrhoid.
- B. Analgesic sprays and witch hazel pads can relieve the pain.
- C. I should lie on my back as much as possible to relieve the pain.
- D. I should drink lots of water and eat foods that have a lot of roughage.
Correct Answer: C
Rationale: Lying on the back increases pressure on hemorrhoids, worsening discomfort; the other statements reflect correct measures.
A preterm neonate who has been stabilized is placed in a radiant warmer and is receiving oxygen via an oxygen hood. While administering oxygen in this manner, the nurse should do which of the following?
- A. Humidify the air being delivered.
- B. Cover the neonate's scalp with a warm cap.
- C. Record the neonate's temperature every 3 to 4 minutes.
- D. Assess the neonate's blood glucose level.
Correct Answer: A
Rationale: Humidifying the air prevents drying of the mucous membranes and maintains airway moisture, which is critical for preterm neonates.
A primigravid client in the second stage of labor feels the urge to push. The client has had no analgesia or anesthesia. Anatomically, which of the following would be the best position for the client to assume?
- A. Dorsal recumbent.
- B. Lithotomy.
- C. Hands and knees.
- D. Squatting.
Correct Answer: D
Rationale: Squatting is anatomically optimal for pushing in the second stage as it widens the pelvic outlet, aligns the fetus with the birth canal, and uses gravity to aid descent. Dorsal recumbent and lithotomy positions restrict pelvic mobility, and hands and knees, while helpful for back pain, is less effective for pushing.
A client asks about the differences between the copper IUD and the hormonal IUD. Which of the following responses by the nurse is accurate?
- A. The copper IUD is hormone-free and may increase menstrual bleeding, while the hormonal IUD may reduce bleeding.
- B. Both IUDs require replacement every year.
- C. The copper IUD prevents ovulation, while the hormonal IUD does not.
- D. The hormonal IUD is less effective than the copper IUD.
Correct Answer: A
Rationale: The copper IUD is hormone-free and may increase menstrual bleeding, while the hormonal IUD releases progestin and may reduce bleeding. Both last several years, neither primarily prevents ovulation, and both are highly effective.
The nurse explains the complications of pregnancy that occur with diabetes to a primigravid client at 10 weeks' gestation who has a 5-year history of insulin-dependent diabetes. Which of the following, if stated by the client as a complication, indicates the need for additional teaching?
- A. Candida albicans infection.
- B. Twin-to-twin transfer.
- C. Polyhydramnios.
- D. Preeclampsia.
Correct Answer: B
Rationale: Twin-to-twin transfer is not a complication of diabetes.