In addition to a maternal history of gestational diabetes me...

The newborn nurse is attending births in the labor and delivery unit.
Nurses' Notes
Labor and Delivery Unit
0000: A 39-year-old client, gravida 4 para 3, at 38 weeks gestation arrives at the labor and delivery unit reporting contractions every 2-3 min. During this pregnancy, the client was diagnosed with gestational diabetes mellitus and prescribed insulin, but she reports not taking the insulin. The client reports cigarette smoking (3-5 cigarettes/day) but denies alcohol or recreational drug use. The client received treatment for bacterial vaginosis during the second trimester. The client has gained 55 lb (25 kg) during the pregnancy. Group B Streptococcus result is negative. 1400: The newborn is delivered via forceps-assisted vaginal birth at
1400. The newborn was immediately placed in skin-to-skin contact with the mother, dried, and stimulated. Apgar scores are 7 at 1 minute and 9 at 5 minutes
1405: Newborn vital signs are T 97.3 F (36.3 C), P 156, and RR 52.
1415: Newborn weight is obtained. The newborn is 9 lb 15 oz (4500 g). The maternal client is assisted to latch the newborn onto the breast.
1430: Slight bruising to the scalp is noted where forceps were applied. Newborn vital signs are T 97.2 F (36.2 C), P 160, RR 55, and SpO 95% on room air.

In addition to a maternal history of gestational diabetes mellitus, the newborn's...... and ..... place the newborn at increased risk for hypoglycemia.

A. Bruising
B. Birth weight
C. Temperature
D. Apgar scores
E. Gestational age

Correct Answer: B,C

Rationale: Macrosomia and hypothermia exacerbate hypoglycemia risk in gestational diabetes.

The nurse is caring for a 12-year-old client.
History and Physical Vital Signs Body System Findings
General- The client has a 2-day history of decreased appetite, nausea, fatigue, and headaches, the client had a "sore throat" 2 weeks ago that resolved without treatment; BMl is in the 65th percentile
Eye, Ears, Nose, and Throat (EENT)- Periorbital edema; no changes in vision
Pulmonary- Lung sounds clear bilaterally; no increased work of breathing; no cough Cardiovascular- S1 and S2 heard on auscultation; no murmur auscultated; 3+ bilateral lower extremity edema is noted
Gastrointestinal- Bowel sounds present, no masses or tenderness felt Musculoskeletal No joint pain or swelling
Genitourinary- Decreased urination; dark, cola-colored urine

Which of the following choices would be appropriate for the client's dietary needs? Select all that apply.

A. Chicken nuggets, ketchup, and carrot sticks
B. Grilled ham and cheese sandwich with pretzels
C. Plain yogurt with oats, honey, and blueberries
D. Slice of pepperoni pizza with a side salad
E. Wheat toast with unsalted peanut butter and banana

Correct Answer: C,E

Rationale: Low-sodium, low-protein options like yogurt with oats and toast with peanut butter are suitable for glomerulonephritis.

Emergency Department
0800: A 43-year-old client comes to the emergency department due to lower
back pain and bilateral leg weakness. The client reports that the
weakness began 3 days ago in the feet and has gradually worsened.
The client sought treatment today after becoming "so weak that I fell
while walking" and noticing new hand weakness and difficulty
swallowing. Back pain radiates down both legs and is rated as 5 on a
scale of 0-10. The client recently recovered from an illness with flu-like
symptoms. The client reports a history of hypertension and takes no
medications. Assessment of the lower extremities reveals muscle
strength of 2/5 and decreased sensation to pinprick. Achilles tendon
and patellar reflexes are decreased.
1000:
The client reports difficulty raising the arms and inability to squeeze the
fingers. The client reports chest tightness and difficulty breathing.
1030:
The client is breathless while speaking. Respirations are shallow and
labored. The client is diaphoretic. The skin is pale and cool. No
audible wheezing or stridor is present.

Which action by the nurse is appropriate?

A. Perform oral suctioning
B. Prepare the client for intubation
C. Reposition the client and encourage deep breathing
D. Request a prescription for an albuterol nebulizer treatment

Correct Answer: B

Rationale: Shallow, labored breathing and chest tightness indicate impending respiratory failure, requiring preparation for intubation.

The nurse is caring for a 6-year-old client accompanied by the parents.
History and Physical
Body System
Findings
General
Client is brought to the emergency department due to
shortness of breath; medical history includes cystic fibrosis
and many previous hospital admissions for pneumonia; in the
3rd percentile for height and weight
Neurological
Alert and oriented to person, place, and time; no neurologic
deficits
Pulmonary
Vital signs: RR 30, SpO, 87% on room air; moderate
subcostal retractions; bilateral wheezing and coarse crackles
throughout lung fields with fine inspiratory crackles at left lung
base; paroxysmal coughing that produces thick, yellow,
blood-tinged sputum; parents report that the client has begun
to become "winded" after showering and other activities Cardiovascular
Vital signs: T 101.7 F (38.7 C), P 130, BP 94/58; skin warm
and dry; peripheral pulses palpable 2+; capillary refill 3
econds; mild finger clubbing noted
Gastrointestinal
Abdomen soft with normoactive bowel sounds; parent states,
"Swallowing the enzyme capsules is very difficult for my child,
and I have noticed an increase in greasy, bulky stools"

For each potential intervention, click to specify if the intervention is indicated or not indicated for the care of the client.

A. Administer antibiotics
B. Administer a bronchodilator
C. Perform chest physiotherapy
D. Administer nebulized hypertonic saline
E. Place the client on airborne isolation precautions

Correct Answer: A,B,C,D

Rationale: Antibiotics treat bacterial pneumonia, bronchodilators relieve wheezing, chest physiotherapy aids mucus clearance, and hypertonic saline thins mucus. Airborne isolation is not indicated for bacterial pneumonia.

The nurse is caring for a 55-year-old client in the clinic.
History and Physical
Body System
Findings: General - The client reports cramping pain in the left calf that has worsened over the past year. The pain is precipitated by walking and is partially relieved with rest. The client reports difficulty walking more than 3 blocks. Height: 72 in (182.9 cm), weight: 250 lb (113.4 kg), BMI: 33.9 kg/m?
Pulmonary- Vital signs are RR 16, SpO, 97% on room air. Client reports smoking 1 pack of cigarettes daily for the past 35 years. Breath sounds are mildly decreased throughout with mild prolonged expiration. Client has a history of chronic obstructive pulmonary disease.
Cardiovascular- Vital signs are T 98.8 F (37.1 C), P 82, BP 146/82. S1 and S2 heard on auscultation. The left lower extremity (LLE) is cooler to touch than the right and appears shiny with sparse hair. LLE pulses: femoral 2+, popliteal 1+, posterior tibia 1+, dorsalis pedis audible with Doppler. LLE capillary refill >3 sec. Client has a history of hypertension.
Gastrointestinal- Client is obese. No tenderness, guarding, masses, bruits, or hepatosplenomegaly.

Which of the following statements should the nurse include in the teaching? Select all that apply.

A. Elevate your legs several times during the day to relieve pain.'
B. Incorporate more fruits and vegetables into your diet.'
C. Inspect your feet daily for any wounds.'
D. Use a heating blanket if your legs get cold.'
E. Walk each day until you have leg pain, rest for 10 minutes, and then continue walking.'

Correct Answer: B,C,E

Rationale: Healthy diet , foot inspections , and supervised walking are appropriate. Elevation is for venous issues, and heating blankets risk burns in poor perfusion.

Which of the following client findings are consistent with a cystic fibrosis exacerbation? Select all that apply.

A. Blood-tinged sputum
B. Greasy, bulky stools
C. Paroxysmal coughing
D. SpO2 of 87% on room air
E. Temperature of 101.7 F (38.7 C)

Correct Answer: A,B,C,D,E

Rationale: Cystic fibrosis exacerbations often present with increased respiratory symptoms (A, C, D), fever , and malabsorption issues due to pancreatic insufficiency.