Nokea
A primiparous client who is bottle-feeding her neonate asks, "When should I start giving the baby solid foods?" The nurse instructs the client to introduce solid foods no sooner than at which age?
- A. 2 months.
- B. 6 months.
- C. 8 months.
- D. 10 months.
Correct Answer: B
Rationale: Solid foods are introduced around 6 months when the infant's digestive system is more mature.
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A primigravid client admitted to the labor area in the upper and lower lower than the lower was born with cystic fibrosis and she wonders if her baby will also have the disease. The nurse can tell the client that cystic fibrosis is:
- A. X-linked recessive and the disease will only occur if the baby is a boy.
- B. X-linked dominant and there is no likelihood of the baby having cystic fibrosis.
- C. Autosomal recessive and that unless the baby's father has the gene, the baby will not have the disease.
- D. Autosomal dominant and there is a 50 per cent chance of the baby having the disease.
Correct Answer: C
Rationale: Cystic fibrosis is an autosomal recessive disorder, requiring both parents to carry the gene for the child to be affected. If the father does not carry the gene, the baby cannot have the disease but may be a carrier. X-linked and dominant inheritance patterns do not apply.
After circumcision with a Plastibell, the nurse should instruct the neonate's mother to cleanse the circumcision site with which of the following?
- A. Warm water.
- B. Povidone-iodine (Betadine) solution.
- C. Diluted hydrogen peroxide.
Correct Answer: A
Rationale: Warm water is recommended for cleansing the circumcision site to keep it clean and promote healing without causing irritation.
The nurse is caring for a neonate at 38 weeks' gestation when the nurse observes marked peristaltic waves on the neonate's abdomen. After this observation, the neonate exhibits projectile vomiting. The nurse notifies the pediatrician because these signs are indicative of which of the following?
- A. Esophageal atresia.
- B. Pyloric stenosis.
- C. Diaphragmatic hernia.
- D. Hiatal hernia.
Correct Answer: B
Rationale: Marked peristaltic waves and projectile vomiting are classic signs of pyloric stenosis, a condition involving hypertrophy of the pylorus muscle.
On the first postpartum day, the primiparous client reports perineal pain of 5 on a scale of 1 to 10 that was unrelieved by ibuprofen 800 mg given 2 hours ago. The nurse should further assess the client for:
- A. Puerperal infection.
- B. Vaginal lacerations.
- C. History of drug abuse.
- D. Perineal hematoma.
Correct Answer: D
Rationale: Persistent perineal pain unrelieved by ibuprofen suggests a perineal hematoma, which requires further assessment.
A primigravid client in active labor has had no anesthesia. The client's cervix is 7 cm dilated, and she is starting to feel considerable discomfort during the first 10 cm to the client's sacral client is a left side-lying position. The nurse should encourage which of the following?
- A. Rapid, shallow chest breathing.
- B. Deep chest breathing.
- C. Rapid pant-blow breathing.
- D. Slow abdominal breathing.
Correct Answer: D
Rationale: Slow abdominal breathing promotes relaxation and oxygenation, helping manage discomfort in active labor without anesthesia. Rapid or shallow breathing may lead to hyperventilation, and deep chest breathing is less effective for pain control.