Nokea
Laboratory reference ranges
Glucose (fasting)
Infant – Within 24 hours after birth
≥40 mg/dL (2.2 mmol/L)
The nurse is caring for assigned newborns. Which of the following newborns should the nurse check first?
- A. a newborn who was delivered 30 minutes ago and has bilateral crackles
- B. a newborn who was delivered 45 minutes ago and has asymmetric arm movement when the Moro reflex is tested
- C. a newborn who was delivered 6 hours ago and has a respiratory rate of 52/min
- D. a newborn who was delivered 12 hours ago, is jittery, and has a serum glucose level of 38 mg/dL (2.1 mmol/L)
Correct Answer: D
Rationale: A glucose level of 38 mg/dL with jitteriness (D) indicates hypoglycemia, a critical condition requiring immediate intervention. Crackles (A), asymmetric Moro reflex (B), and respiratory rate of 52 (C) are less urgent.
You may also like to solve these questions
The nurse is giving home care to a 69-year-old client who has severe arthritis. Which comment made by the client would indicate to the nurse that the client is experiencing normal changes associated with the aging process?
- A. I have such a hard time with the pain in my feet and knees.
- B. I have had loose stools for the last few months.
- C. My children say I keep my apartment too warm.
- D. I have a hard time at night because the lights are all big and fuzzy.
Correct Answer: C
Rationale: Feeling cold and preferring a warmer environment is a normal age-related change due to decreased thermoregulation. Pain, loose stools, and visual changes may indicate pathology requiring further investigation.
The nurse reviews the admission history of a 70-year-old client diagnosed with chronic obstructive pulmonary disease (COPD). Which of the following statements by the client does the nurse recognize as contributing to the development of COPD? Select all that apply.
- A. I have been drinking alcohol almost daily since age 20.'
- B. I have been overweight for as long as I can remember.'
- C. I have smoked about a pack of cigarettes a day since I was 16 years old but quit last year.'
- D. I know I eat too much fast food.'
- E. I was a car mechanic for about 40 years and had my own garage.'
Correct Answer: C, E
Rationale: Smoking (C) is a primary cause of COPD. Occupational exposure to chemicals as a mechanic (E) is also a risk factor. Alcohol (A), obesity (B), and fast food (D) are not directly linked to COPD.
A nurse is reinforcing teaching to the parent of a child who has a new diagnosis of absence seizures. Which statement by the parent indicates understanding of the teaching?
- A. My child may experience incontinence.'
- B. My child may seem confused afterwards.'
- C. My child may stare and seem inattentive.'
- D. My child will notice unusual odors prior to the event.'
Correct Answer: C
Rationale: Staring and inattention (C) are hallmark signs of absence seizures. Incontinence (A) and confusion (B) are more typical of other seizures, and odors (D) suggest an aura, not typical in absence seizures.
The nurse is talking to a client with rheumatoid arthritis who is reporting increased pain and stiffness of the joints in the morning. The nurse should encourage the client to
- A. apply a heating pad to the affected joints for a minimum of 30 minutes every morning
- B. consume a meal that is high in calories and carbohydrates every morning
- C. take a warm shower and perform range-of-motion exercises every morning
- D. take nonsteroidal anti-inflammatory medication before breakfast every morning
Correct Answer: C
Rationale: A warm shower and range-of-motion exercises (C) reduce morning stiffness and improve mobility. Heating pads (A) may help but are less comprehensive, high-calorie meals (B) are irrelevant, and NSAIDs (D) may not address stiffness immediately.
The LPN/LVN is providing home care to an elderly widow who has senile dementia. The woman tells the nurse that her daughter hits her and tells her to shut up. The nurse notes one ecchymotic area on the client's right forearm. The daughter seems attentive to the woman when the nurse is present. What action should the nurse take?
- A. Immediately call the police
- B. Ask the daughter why she abuses her mother
- C. Ask the physician to order long bone x-rays
- D. Report the woman's remarks and the nurse's findings to the nursing supervisor
Correct Answer: D
Rationale: Reporting suspected abuse to the supervisor initiates investigation and protection, the appropriate action for potential elder abuse.