Nokea
In teaching mothers-to-be about infant nutrition, which instruction should the nurse provide?
- A. Supplement breast milk with corn syrup.
- B. Give cow’s milk during the first year of life.
- C. Add honey to infant formulas for increased energy.
- D. Provide breast milk or formula for the first 4 to 6 months.
Correct Answer: D
Rationale: The correct answer is D because breast milk or formula is recommended for the first 4 to 6 months as it provides essential nutrients for infant growth and development. Choosing A, B, or C is incorrect as they pose health risks to infants - corn syrup is not necessary, cow's milk is not suitable for infants, and honey can cause botulism in infants under 1 year old. Breast milk or formula is the safest and most nutritionally balanced option for infants in the first few months of life.
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The patient has been diagnosed with cardiovascular disease and placed on a low-fat diet. The patient asks the nurse, “How much fat should I have? I guess the less fat, the better.” Which information will the nurse include in the teaching session?
- A. Cholesterol intake needs to be less than 300 mg/day.
- B. Fats have no significance in health and the incidence of disease.
- C. All fats come from external sources so this can be easily controlled.
- D. Deficiencies occur when fat intake falls below 10% of daily nutrition.
Correct Answer: D
Rationale: The correct answer is D: Deficiencies occur when fat intake falls below 10% of daily nutrition.
Rationale:
1. Fat is essential for absorption of fat-soluble vitamins (A, D, E, K) and for maintaining healthy cell membranes.
2. Fat provides essential fatty acids (omega-3, omega-6) crucial for brain function and inflammation regulation.
3. Adequate fat intake prevents deficiencies like dry skin, poor wound healing, and hormonal imbalances.
4. A low-fat diet should still include at least 10% of daily nutrition from healthy fats for optimal health.
Summary:
A: Cholesterol intake is important but not the primary focus for a low-fat diet.
B: Fats are significant for health, and extreme low-fat diets can lead to deficiencies.
C: While some fats are from external sources, the body needs a minimum amount for proper functioning.
A patient, who delivered her third child yesterday, has just learned that her two school-age children have contracted chickenpox. What should the nurse tell her?
- A. Her two children should be treated with acyclovir before she goes home from the hospital.
- B. The baby will acquire immunity from her and will not be susceptible to chickenpox.
- C. The children can visit their mother and baby in the hospital as planned but must wear gowns and masks.
- D. She must make arrangements to stay somewhere other than her home until the children are no longer contagious.
Correct Answer: D
Rationale: The correct answer is D: She must make arrangements to stay somewhere other than her home until the children are no longer contagious.
1. The patient's newborn is at risk of contracting chickenpox from the infected children.
2. Chickenpox can be severe in newborns due to their immature immune systems.
3. It is crucial to protect the newborn by ensuring they are not exposed to the virus.
4. Staying elsewhere until the children are no longer contagious will prevent transmission to the newborn.
Incorrect choices:
A: Acyclovir is not recommended for prophylactic treatment in this situation.
B: Immunity is not automatically transferred from the mother to the baby for chickenpox.
C: Allowing the infected children to visit with precautions is not sufficient to protect the newborn.
A patient has just returned to the surgical floor after undergoing a retinal detachment repair. The postoperative orders specify that the patient should be kept in a prone position until otherwise ordered. What should the nurse do?
- A. Call the physician and ask for the order to be confirmed.
- B. Follow the order because this position will help keep the retinal repair intact.
- C. Instruct the patient to maintain this position to prevent bleeding.
- D. Reposition the patient after the first dressing change.
Correct Answer: B
Rationale: Correct Answer: B
Rationale:
1. Prone position post retinal detachment repair helps the gas bubble or silicone oil stay against the retina to support healing.
2. This position prevents the bubble/oil from moving and causing further detachment.
3. Repositioning can jeopardize the surgical repair and lead to complications.
4. Calling the physician (A) is unnecessary as the order is clear.
5. Instructing the patient to prevent bleeding (C) is not related to the positioning after retinal detachment repair.
6. Repositioning after the first dressing change (D) contradicts the initial order and risks complications.
A man comes to the clinic complaining that he is having difficulty obtaining an erection. When reviewing the patients history, what might the nurse note that contributes to erectile dysfunction?
- A. The patient has been treated for a UTI twice in the past year.
- B. The patient has a history of hypertension.
- C. The patient is 66 years old.
- D. The patient leads a sedentary lifestyle.
Correct Answer: B
Rationale: The correct answer is B: The patient has a history of hypertension. Hypertension is a risk factor for erectile dysfunction as it can lead to reduced blood flow to the penis, impacting the ability to achieve and maintain an erection. High blood pressure can damage blood vessels and affect the circulation necessary for an erection. Other choices are less likely to directly contribute to erectile dysfunction. A: UTI treatment is not typically associated with erectile dysfunction. C: Age alone is not a direct cause of erectile dysfunction, although it can increase the risk. D: While a sedentary lifestyle can impact overall health, it is less likely to directly cause erectile dysfunction compared to hypertension.
A patient is being discharged home from the ambulatory surgery center after an incisional biopsy of a mass in her left breast. What are the criteria for discharging this patient home? Select all that apply.
- A. Patient must understand when she can begin ambulating
- B. Patient must have someone to accompany her home
- C. Patient must understand activity restrictions
- D. Patient must understand care of the biopsy site E) Patient must understand when she can safely remove her urinary catheter
Correct Answer: A
Rationale: Step-by-step rationale for why answer A is correct:
1. Ambulating is a crucial postoperative activity to prevent complications like blood clots.
2. Understanding when to ambulate ensures the patient follows proper recovery guidelines.
3. Proper ambulation aids in preventing postoperative complications and promotes healing.
Summary of why other choices are incorrect:
B. Having someone accompany the patient is important for support but not a strict criteria for discharge.
C. While understanding activity restrictions is important, it is not a specific criteria for immediate discharge.
D. Understanding care for the biopsy site is essential but not a strict criteria for immediate discharge.
E. Removal of a urinary catheter is not typically related to discharge criteria for a breast biopsy.