Which of the following conditions should the nurse identify as being consistent with the adolescent's assessment findings? For each finding click to specify if the assessment findings are consistent with trichomoniasis, gonorrhea, or candidiasis. Each finding may support more than one disease process.
- A. Abdominal pain.
- B. Greenish discharge.
- C. Diabetes.
- D. Pain on urination.
- E. Absence of condom.
Correct Answer: B, D
Rationale: To determine the correct answer, we need to identify which assessment findings are consistent with trichomoniasis, gonorrhea, or candidiasis.
B: Greenish discharge is consistent with both trichomoniasis and gonorrhea due to their characteristic discharge color.
D: Pain on urination is a common symptom of gonorrhea, making it consistent with this condition.
Therefore, the correct answer is , as Greenish discharge and Pain on urination are consistent with gonorrhea. Abdominal pain and Diabetes are not specific to any of the mentioned conditions.
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A nurse is teaching a client who is at 37 weeks of gestation and has a prescription for a nonstress test. Which of the following instructions should the nurse include?
- A. The test should take 10 to 15 minutes to complete.
- B. You will lie in a supine position throughout the test.
- C. You should not eat or drink for hours before the test.
- D. You should press the handheld button when you feel your baby move.
Correct Answer: D
Rationale: The correct answer is D: You should press the handheld button when you feel your baby move. In a nonstress test, the client is required to press a handheld button whenever they feel the baby move. This action helps to correlate fetal movements with changes in the fetal heart rate, allowing healthcare providers to assess the baby's well-being. This active participation from the client ensures accurate monitoring of the baby's condition. The other choices are incorrect because: A: The duration of a nonstress test can vary but typically takes around 20-40 minutes. B: Lying in a supine position is not recommended during pregnancy as it can decrease blood flow to the baby. C: It is important for the client to have a light meal before the test to ensure the baby is active during monitoring.
A nurse is observing a new guardian caring for their crying newborn who is bottle feeding. Which of the following actions by the guardian should the nurse recognize as a positive parenting behavior?
- A. Lays the newborn across their lap and gently sways.
- B. Places the newborn in the crib in a prone position.
- C. Offers the newborn a pacifier dipped in formula.
- D. Prepares a bottle of formula mixed with rice cereal.
Correct Answer: A
Rationale: The correct answer is A because laying the newborn across the lap and gently swaying can help soothe the baby by providing comfort and closeness. This position mimics the feeling of being held in the womb and the swaying motion can be calming. Placing the newborn in the crib in a prone position (B) is not recommended due to the risk of sudden infant death syndrome. Offering a pacifier dipped in formula (C) may lead to overfeeding and potential nipple confusion. Preparing a bottle of formula mixed with rice cereal (D) is not recommended for newborns as their digestive systems are not ready for solids.
A nurse is caring for a client who is in labor and receiving oxytocin. Which of the following findings indicates that the nurse should increase the rate of infusion?
- A. Contractions every 5 min that last 30 seconds
- B. Montevideo units consistently 300 mm Hg
- C. Urine output of 20 mL/hr
- D. FHR pattern with absent variability
Correct Answer: A
Rationale: The correct answer is A because contractions every 5 minutes that last 30 seconds indicate increased frequency and duration, which may not be sufficient for effective labor progress. Increasing the rate of oxytocin can help strengthen contractions for more efficient labor. Choices B, C, and D do not indicate the need to increase the rate of infusion. Montevideo units measure the strength of contractions, urine output reflects renal perfusion, and absent variability in fetal heart rate suggests fetal distress, not the need for increased oxytocin.
A nurse is caring for a client who has preeclampsia and is receiving a continuous infusion of magnesium sulfate IV. Which of the following actions should the nurse take?
- A. Restrict hourly fluid intake to 150 mL/hr.
- B. Have calcium gluconate readily available.
- C. Assess deep tendon reflexes every 6 hr.
- D. Monitor intake and output every 4 hr.
Correct Answer: B
Rationale: The correct answer is B: Have calcium gluconate readily available. Magnesium sulfate can lead to magnesium toxicity, causing respiratory depression and cardiac arrest. Calcium gluconate is the antidote for magnesium toxicity, so having it readily available is crucial for immediate administration if toxicity occurs. Option A is incorrect as fluid intake should not be restricted in preeclampsia. Option C is incorrect as deep tendon reflexes should be assessed more frequently (every 1-2 hours) due to the risk of hypermagnesemia. Option D is incorrect as intake and output should be monitored hourly to detect any changes in renal function.
A nurse is providing teaching to the parents of a newborn about newborn genetic screening. Which of the following statements should the nurse Include in the teaching?
- A. This test will be repeated when your baby is 2 months old.
- B. A nurse will draw blood from your baby's inner elbow.
- C. This test should be performed after your baby is 24 hours old.
- D. Your baby will be given 2 ounces of water to drink prior to the test.
Correct Answer: C
Rationale: Rationale: The correct answer is C because newborn genetic screening should be performed after the baby is 24 hours old to ensure accurate results. Testing too early may lead to false negatives. Choice A is incorrect because the test is typically done once soon after birth. Choice B is incorrect as blood is usually drawn from the baby's heel, not inner elbow. Choice D is incorrect as newborns should not be given water before the test due to risk of aspiration.