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The client delivered hours ago and has a boggy uterus displaced above and to the right of the umbilicus. What action should the nurse take?
- A. Inspect the perineal pad.
- B. Encourage voiding.
- C. Monitor vital signs.
- D. Notify the healthcare provider.
Correct Answer: B
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
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A full-term, 24-hour-old infant in the nursery regurgitates and suddenly turns cyanotic. What should the nurse do first?
- A. Suction the oral and nasal passages.
- B. Give oxygen by positive pressure.
- C. Stimulate the infant to cry.
- D. Turn the infant onto the right side.
Correct Answer: A
Rationale: In a situation where an infant regurgitates and turns cyanotic, the priority action should be to clear any potential airway obstruction. Suctioning the oral and nasal passages is crucial to ensure the infant's airway is clear and allow for proper breathing. This intervention takes precedence over providing oxygen, stimulating the infant to cry, or repositioning the infant.
The healthcare provider is providing preconception counseling. Which supplement should the provider recommend to help prevent the occurrence of anencephaly?
- A. Folic Acid.
- B. Calcium.
- C. Iron.
- D. Vitamin D.
Correct Answer: A
Rationale: Folic acid supplementation before and during early pregnancy is crucial for reducing the risk of neural tube defects, including anencephaly. Anencephaly is a severe birth defect in which a baby is born without parts of the brain and skull. Folic acid plays a key role in neural tube development and can significantly lower the chances of such defects when taken prior to conception and in early pregnancy.
The healthcare provider prescribes Amoxicillin 500mg PO every 8hrs for a child who weighs 22 pounds. The available suspension is labeled Amoxicillin Suspension 250mg/5ml. The recommended maximum dose is 50mg/kg/24hr. How many mL should the nurse administer in a single dose based on the child's weight?
- A. 10mL
- B. 15mL
- C. 7.5mL
- D. 5mL
Correct Answer: A
Rationale: To calculate the dose for the child weighing 22 pounds, first convert the weight to kg: 22 lbs · 2.2 = 10 kg. The maximum dose based on weight would be 10 kg 50 mg/kg/24hr = 500 mg/24hr. Since the medication is prescribed every 8 hours, the dose for each administration would be 500 mg · 3 doses = 166.67 mg. As the available suspension is 250mg/5ml, the nurse should administer 166.67 mg · 250 mg/mL = 0.67 mL per dose. However, since it's not practical to administer a fraction of a milliliter, the nurse should round up to the nearest appropriate dose, which is 10mL.
The LPN/LVN is counseling a woman who wants to become pregnant. The woman tells the nurse that she has a 36-day menstrual cycle and the first day of her last menstrual period was January 8. The nurse calculates that the woman's next fertile period is
- A. January 14-15.
- B. January 22-23.
- C. January 30-31.
- D. February 6-7.
Correct Answer: C
Rationale: To determine the fertile period, subtract 14 days from the length of the woman's menstrual cycle. In this case, 36-14 = 22. Counting forward from the first day of the last menstrual period (January 8), the fertile period falls around January 30-31. This is because ovulation typically occurs approximately 14 days before the start of the next menstrual period, marking the fertile window for conception.
A child with glomerulonephritis is asking for strawberries. What should the nurse do?
- A. Allow the child to eat strawberries.
- B. Restrict the child's diet.
- C. Give the child a low-protein diet.
- D. Increase the child's fluid intake.
Correct Answer: B
Rationale: In glomerulonephritis, it is crucial to restrict the child's diet, particularly avoiding foods high in potassium like strawberries. Potassium restriction is essential because impaired kidney function in glomerulonephritis can lead to potassium retention, potentially causing hyperkalemia. Therefore, the nurse should restrict the child's diet to manage their condition effectively.