Nokea
A nurse is caring for a newborn who has jaundice and a new prescription for phototherapy. Which of the following actions should the nurse take?
- A. Provide the newborn with 15 mL glucose water after each feeding.
- B. Turn the newborn every 4 hr.
- C. Apply hydrating lotion to the newborn’s skin prior to treatment.
- D. Close the newborn's eyes before applying eyepatches.
Correct Answer: D
Rationale: The correct answer is D: Close the newborn's eyes before applying eyepatches. To protect the newborn's eyes from potential damage due to phototherapy light, it is essential to close the eyes before placing eyepatches. This prevents exposure to the bright light, reducing the risk of eye irritation or injury. Providing glucose water (A), turning the newborn every 4 hours (B), and applying hydrating lotion (C) are not directly related to the phototherapy treatment for jaundice. Closing the eyes before applying eyepatches is crucial for the safety and comfort of the newborn during the phototherapy session.
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A nurse is caring for a client who is at 20 weeks of gestation and has trichomoniasis. Which of the following findings should the nurse expect?
- A. Thick, white vaginal discharge
- B. Urinary frequency
- C. Vulva lesions
- D. Malodorous discharge
Correct Answer: D
Rationale: The correct answer is D: Malodorous discharge. Trichomoniasis is a sexually transmitted infection caused by a parasite, resulting in a foul-smelling, greenish-yellow vaginal discharge. This characteristic discharge is due to the infection and inflammation of the vaginal mucosa. Option A (Thick, white vaginal discharge) is more indicative of a yeast infection, while option B (Urinary frequency) is not specific to trichomoniasis. Option C (Vulva lesions) is not a common symptom of trichomoniasis. Overall, the malodorous discharge is the key finding in diagnosing trichomoniasis at 20 weeks of gestation.
A nurse is assessing a late preterm newborn. Which of the following manifestations is an indication of hypoglycemia?
- A. Hypertonia
- B. Increased feeding
- C. Hyperthermia
- D. Respiratory distress
Correct Answer: D
Rationale: The correct answer is D: Respiratory distress. Hypoglycemia in a late preterm newborn can lead to inadequate energy supply to the respiratory muscles, resulting in respiratory distress. Hypertonia (A) is not a typical manifestation of hypoglycemia in newborns. Increased feeding (B) is a common response to hunger but not a direct indication of hypoglycemia. Hyperthermia (C) is not a typical sign of hypoglycemia. In summary, respiratory distress is a key clinical manifestation of hypoglycemia in late preterm newborns, making it the correct choice.
Which of the following tests is used to assess fetal lung maturity?
- A. Non-stress test
- B. Biophysical profile
- C. Amniocentesis
- D. Lecithin-sphingomyelin (L/S) ratio
Correct Answer: D
Rationale: The correct answer is D: Lecithin-sphingomyelin (L/S) ratio. This test is used to assess fetal lung maturity by measuring the ratio of two substances found in the amniotic fluid. An L/S ratio greater than 2:1 is indicative of mature fetal lungs. This test is crucial in determining if a baby can breathe adequately after birth. The other choices are incorrect because: A) Non-stress test monitors fetal heart rate and movements, B) Biophysical profile assesses fetal well-being, and C) Amniocentesis is a procedure to collect amniotic fluid for genetic testing.
Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
- A. Initiate anticoagulant therapy, Administer an oxytocic medication, Apply ice packs to the breasts.
- B. Engorgement, Urinary tract infection, Deed vein thrombosis
- C. Temperature, Circumference of lower extremities, Integrity of the nipples
Correct Answer:
Rationale:
Which of the following is a potential complication of oligohydramnios?
- A. Preterm labor
- B. Fetal growth restriction
- C. Polyhydramnios
- D. All of the above
Correct Answer: B
Rationale: The correct answer is B: Fetal growth restriction. Oligohydramnios is a condition characterized by low amniotic fluid levels, which can lead to poor fetal growth due to decreased cushioning and space for the fetus to move and grow. This can result in intrauterine growth restriction and potential complications for the baby. Preterm labor (choice A) can also be associated with oligohydramnios due to issues with placental function, but it is not a direct complication of low amniotic fluid levels. Polyhydramnios (choice C) is the opposite condition of oligohydramnios and is not a potential complication of it. Therefore, the correct answer is B as it directly relates to the impact of oligohydramnios on fetal growth.