Nokea
The nurse is caring for a high-risk newborn with an umbilical catheter in a radiant warmer. The nurse notes blanching of the feet. Which is the most appropriate nursing action?
- A. Elevate feet 15 degrees.
- B. Place socks on newborn.
- C. Wrap feet loosely in prewarmed blanket.
- D. Report findings immediately to the practitioner.
Correct Answer: C
Rationale: When the nurse notes blanching of the feet in a high-risk newborn with an umbilical catheter in a radiant warmer, the most appropriate nursing action is to wrap the feet loosely in a prewarmed blanket. Blanching indicates poor circulation to the area, which can be a result of cold stress or constriction of blood vessels. By wrapping the feet in a prewarmed blanket, the nurse can help to restore adequate blood flow to the feet and improve circulation. This action addresses the potential cause of the blanching and promotes the newborn's comfort and well-being.
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What equipment should the nurse prepare for the primary care provider when a woman says she is concerned about possible Chlamydia infection?
- A. Chlamydia slide
- B. Chlamydia collection kit
- C. Chlamydia swab
- D. Chlamydia wet mount
Correct Answer: B
Rationale: When a woman expresses concerns about a possible Chlamydia infection, the nurse should prepare a Chlamydia collection kit for the primary care provider. This kit typically includes everything needed to collect a specimen for testing, such as a swab for the patient to provide a genital sample. This sample can then be sent to a laboratory for testing to confirm the presence of Chlamydia. Having the appropriate collection kit ready ensures that the primary care provider can promptly gather the necessary information to make an accurate diagnosis and provide appropriate treatment if needed.
A nurse is preparing to feed a 12-month-old infant with failure to thrive. Which intervention should the nurse implement?
- A. Provide stimulation during feeding.
- B. Avoid being persistent during feeding time.
- C. Limit feeding time to 10 minutes.
- D. Maintain a face-to-face posture with the infant during feeding.
Correct Answer: A
Rationale: Providing stimulation during feeding is the most appropriate intervention for a 12-month-old infant with failure to thrive. Infants with failure to thrive may have decreased interest in feeding or difficulty with obtaining adequate nutrition. By providing stimulation during feeding, such as making eye contact, talking gently, and playing soft music, the nurse can help increase the infant's interest and engagement in feeding. This can lead to improved feeding outcomes and help the infant receive the necessary nutrition for growth and development.
A nurse is performing a gestational age assessment on a newborn. The nurse determines that the newborn is "term" if which findings are assessed? (Select all that apply.)
- A. Posture with fully flexed arms and legs
- B. Arm recoil brisk
- C. Square window at 90 degrees
- D. Scarf sign of elbow crossing over the midline
Correct Answer: A
Rationale: Failed to generate a rationale of 500+ characters after 5 retries.
A patient has been prescribed bumetanide (Bumex) every morning for control of hypertension. Which of the ff. statements indicates correct knowledge of the treatment regimen?
- A. "I can travel to Florida and sunbathe all day."
- B. "Now I can eat whatever I want, whenever I want."
- C. "I'll take my medication in the morning, every morning."
- D. "I won't need medication once my pressure goes down."
Correct Answer: C
Rationale: The correct statement indicating the patient has a good understanding of the treatment regimen is statement C: "I'll take my medication in the morning, every morning." This statement shows that the patient acknowledges the importance of taking their prescribed bumetanide (Bumex) every morning as directed. Consistency in taking the medication as prescribed is crucial for the effective control of hypertension. Statements A and B are unrelated to the treatment regimen and do not address medication adherence. Statement D reflects a misconception that medication can be stopped once blood pressure decreases, which is inaccurate and potentially harmful.
A client is scheduled to receive methotrexate (Folex), 0.625 mg/kg P.O. daily, to treat malignant lymphoma. Before administering the drug, the nurse reviews the client's medication history. Which of the following drugs might interact with methotrexate?
- A. digoxin (Lanoxin)
- B. Probenecid (Benemid)
- C. theophylline (Slo-Phyllin)
- D. Famotidine (Pepcid)
Correct Answer: B
Rationale: Probenecid is a drug that can interact with methotrexate by inhibiting its renal tubular secretion, leading to increased methotrexate levels and potential toxicity. It is essential to monitor the client closely for signs of methotrexate toxicity if both drugs are being used concurrently. The other options, digoxin, theophylline, and famotidine, do not have significant interactions with methotrexate that would result in increased toxicity.