Nokea
After the introduction of the Back to Sleep campaign in 1992, an increased incidence has been noted of which of the following pediatric disorders? (Select all that apply.)
- A. SIDS
- B. Torticollis
- C. Failure to thrive
- D. Apnea of infancy
Correct Answer: B
Rationale: After the introduction of the Back to Sleep campaign in 1992, which encouraged placing infants on their backs to sleep to reduce the risk of Sudden Infant Death Syndrome (SIDS), an increased incidence has been noted of Torticollis (B) and Plagiocephaly (E).
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A 16 y.o. girl is diagnosed with genital herpes. She is tearful and as she asks what she can do to prevent complications of the disease. Based on the data provided, which nursing diagnosis is appropriate for her plan of care?
- A. Risk for transmission of infection
- B. Pain
- C. Health-seeking behaviours
- D. Ineffective sexuality pattern
Correct Answer: A
Rationale: Given that the 16-year-old girl has been diagnosed with genital herpes and is concerned about preventing complications of the disease, the most appropriate nursing diagnosis would be "Risk for transmission of infection." Genital herpes is a highly contagious sexually transmitted infection, and individuals with the infection can transmit it to their partners through sexual contact. Therefore, it is crucial to educate the girl on ways to prevent the transmission of the infection to others. By addressing this nursing diagnosis, the healthcare team can provide guidance on safer sexual practices, including the use of condoms, abstinence during outbreaks, and communication with partners to prevent the spread of the infection. This nursing diagnosis focuses on promoting the girl's health and preventing further complications related to the transmission of genital herpes.
The nurse is caring for a newborn with hyperbilirubinemia who is receiving phototherapy. Which is an appropriate nursing intervention for this newborn?
- A. Apply lotion as prescribed to moisturize skin.
- B. Maintain nothing-by-mouth (NPO) status to prevent nausea and vomiting.
- C. Monitor temperature to prevent hypothermia or hyperthermia.
- D. Keep eye patches on for at least 8 to 12 of every 24 hours.
Correct Answer: C
Rationale: Monitoring temperature to prevent hypothermia or hyperthermia is an appropriate nursing intervention for a newborn with hyperbilirubinemia receiving phototherapy. Phototherapy can increase the risk of hypothermia in newborns due to increased heat loss from evaporation, convection, and conduction. On the other hand, hyperthermia can occur if the newborn is over-wrapped or placed too closely to the light source. Therefore, frequent temperature monitoring is essential to maintain a stable body temperature within a normal range and prevent adverse effects related to temperature dysregulation.
Which is the most appropriate nursing action when intermittently gavage-feeding a preterm newborn?
- A. Allow formula to flow by gravity.
- B. Insert tube through nares rather than mouth.
- C. Avoid letting newborn suck on tube.
- D. Apply steady pressure to syringe to deliver formula to stomach in a timely manner.
Correct Answer: C
Rationale: The most appropriate nursing action when intermittently gavage-feeding a preterm newborn is to avoid letting the newborn suck on the tube. Preterm infants are at risk for disorganized feeding patterns and can develop a non-nutritive sucking habit when the tube is in their mouth. Allowing them to suck on the tube can lead to difficulty transitioning to oral feeding once they are ready, as they may associate feeding with the tube rather than with proper suckling at the breast or bottle. Therefore, it is important to prevent non-nutritive sucking during gavage feedings to promote successful oral feeding later on.
Nearly all cervical carcinomas contain human papillomavirus (HPV). Which of the following types is never associated with such malignancy?
- A. type6
- B. type 16
- C. type 18
- D. type 31
Correct Answer: A
Rationale: HPV type 6 is typically associated with low-grade lesions and genital warts, not cervical carcinoma.
The nurse is caring for a newborn who was born 24 hours ago to a mother who received no prenatal care. The newborn is a poor feeder but sucks avidly on his hands. Clinical manifestations also include loose stools, tachycardia, fever, projectile vomiting, sneezing, and generalized sweating. Which should the nurse suspect?
- A. Seizure disorder
- B. Narcotic withdrawal
- C. Placental insufficiency
- D. Meconium aspiration syndrome
Correct Answer: B
Rationale: The clinical manifestations described in the scenario are classic signs of neonatal abstinence syndrome (NAS), which occurs in newborns who were exposed to drugs, particularly narcotics, in utero. The newborn's symptoms of poor feeding, sucking on his hands, tachycardia, fever, projectile vomiting, loose stools, sneezing, and generalized sweating are consistent with NAS. These symptoms occur as the newborn experiences withdrawal from the drugs to which they were exposed during pregnancy. In this case, the lack of prenatal care suggests that the mother may have used narcotics during pregnancy, leading to NAS in the newborn. It is essential for healthcare providers to recognize these signs and provide appropriate care and support for infants experiencing NAS.