Nokea
The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care?
- A. Softening unpleasant information or prognoses
- B. Evaluating and changing the nursing plan of care
- C. Collaborating with the child and family as equals
- D. Showing respect for the family's beliefs and wishes
Correct Answer: A
Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses.
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Which foods control option. Which is the most effective and should she discuss?
- A. Whole grains
- B. Copper intrauterine device
- C. Meats
- D. Cervical cap
Correct Answer: B
Rationale: Among the options provided, the most effective birth control method is the copper intrauterine device (IUD). IUDs are over 99% effective at preventing pregnancy and provide long-term contraception without the need for daily management. Copper IUDs work by releasing copper ions that are toxic to sperm, thus preventing fertilization. It is a reversible form of birth control and can be easily removed if a person decides to become pregnant. Additionally, IUDs do not contain hormones, making them a suitable option for individuals who prefer non-hormonal birth control methods. It is advisable for the individual to discuss the possibility of using a copper IUD with their healthcare provider to determine if it is the right choice for them based on their specific health needs and preferences.
The nurse is monitoring a client in labor. What finding indicates the transition phase?
- A. Cervix dilated to 4 cm.
- B. Cervix dilated to 8 cm.
- C. Irregular contractions.
- D. Client reports feeling the urge to push.
Correct Answer: B
Rationale: The transition phase is marked by cervical dilation of 8–10 cm, intense contractions, and significant discomfort.
The nurse is assessing a postpartum client who is breastfeeding. What finding requires further evaluation?
- A. Engorgement on day 3 postpartum.
- B. Mild nipple tenderness.
- C. Cracked and bleeding nipples.
- D. Colostrum present in the first 48 hours.
Correct Answer: C
Rationale: Cracked and bleeding nipples may indicate poor latch or incorrect breastfeeding technique, requiring intervention.
The nurse is monitoring a client with gestational hypertension. What symptom requires immediate intervention?
- A. Weight gain of 1 pound in a week.
- B. Slight swelling of the hands and feet.
- C. Severe headache and vision changes.
- D. Blood pressure of 135/85 mmHg.
Correct Answer: C
Rationale: Severe headache and vision changes may indicate preeclampsia and require immediate evaluation.
What signs/symptoms should prompt a woman to seek assessment for ovarian cancer?
- A. Vaginal bleeding and weight loss.
- B. Frequent urination, breast tenderness, and extreme fatigue.
- C. Abdominal pain, bloating, and a constant feeling of fullness.
- D. Hardness on one side of the abdomen.
Correct Answer: C
Rationale: Abdominal symptoms are common in ovarian cancer.