Nokea
If the following snacks are available, which one is best to meet the child's need for protein?
- A. Strawberry milkshake
- B. A popsicle stick with cinnamon
- C. Cubes of flavored gelatin
- D. Warmed beef broth
Correct Answer: D
Rationale: Warmed beef broth is a high-protein snack suitable for a burn patient, providing protein needed for tissue repair and wound healing, unlike the other options, which are lower in protein.
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The nurse completes teaching in preparation to discharge a mother and her 48-hour-old,full-term newborn. The nurse determines there is a need for further instruction about infant car safety when the newborn’s father is overheard making which statement?
- A. “We need to face the infant car seat toward the back of the car.”
- B. “I disarmed one front seat air bag so we can put the car seat in the front seat.”
- C. “Let’s check the car seat to make sure it will position the baby at a 45-degree angle.”
- D. “I know the baby will need to be in the infant car seat until he is over 20 pounds.”
Correct Answer: B
Rationale: The rear seat is safest for infants; air bags should not be disarmed for front-seat placement. Rear-facing 45-degree angle and car seat use until 20 lb are correct.
The nurse is administering surfactant via ET tube to a 48-hour-old preterm infant with respiratory distress syndrome (RDS). The father asks the nurse how this treatment will help his baby. The nurse should explain that the preterm infant is unable to produce adequate amounts of surfactant and that giving it to his baby will have what effect?
- A. Increase PaCO2 levels in the bloodstream
- B. Prevent collapse of the alveoli
- C. Decrease PaO2 levels in the bloodstream
- D. Prevent pleural effusion
Correct Answer: B
Rationale: Surfactant prevents alveolar collapse in RDS improving gas exchange decreasing PaCO2 and increasing PaO2. Pleural effusion is unrelated.
Which statement by the parents indicates they understand the home care needs for a child with sickle cell anemia?
- A. We'll limit our child's fluid intake to prevent swelling.
- B. We'll encourage our child to rest during sickle cell crises.
- C. We'll give our child aspirin for fever.
- D. We'll avoid taking our child to the doctor for regular checkups.
Correct Answer: B
Rationale: Encouraging rest during sickle cell crises reduces oxygen demand and prevents exacerbation of vaso-occlusive episodes, indicating understanding of home care needs.
Maximum normal time for second stage of labour in primigravida without anaesthesia is about:
- A. 20 minutes.
- B. 60 minutes.
- C. 120 minutes.
- D. 240 minutes.
- E. There is no normal maximum.
Correct Answer: C
Rationale: The second stage in primigravida without anesthesia is typically up to 2 hours (120 minutes). Beyond this intervention is considered due to risks of maternal or fetal distress.
A breastfeeding mother is being discharged with her 2-day-old,full-term newborn. The nurse recognizes that the mother understands how to determine if her newborn is getting enough breast milk when making which statement?
- A. “He should have at least three wet diapers tomorrow.”
- B. “He should have one stool per day during the next week.”
- C. “At his 1-week checkup,he should weigh an additional 8 ounces.”
- D. “He should nurse for 5 minutes on each breast to get enough milk.”
Correct Answer: A
Rationale: A 3-day-old should have at least three wet diapers indicating adequate intake. Breastfed infants stool 3–10 times daily lose 5–10% birth weight initially and nurse 10–20 minutes per breast.