Nokea
The nurse is educating a client with gestational hypertension about home care. What instruction should the nurse include?
- A. Monitor your blood pressure once a week.
- B. Report any sudden swelling or weight gain.
- C. Increase sodium intake to maintain hydration.
- D. Avoid taking daily medications.
Correct Answer: B
Rationale: Sudden swelling or rapid weight gain may indicate worsening gestational hypertension or preeclampsia.
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The nurse teaches a new mother that neonatal weight loss in the first 3 days of life is most often the result of:
- A. Allergy to formula
- B. a hypoglycemic response
- C. Inadequate breast or formula feeding
- D. Excretion of fluid via lungs, urinary bladder and bowels.
Correct Answer: D
Rationale: Fluid loss is the primary cause of early weight loss.
In teaching parents to use a bulb syringe to suction an infant, the nurse should teach them to:
- A. suction the back of the throat vigorously.
- B. always suction the nose before suctioning the mouth.
- C. use it only once a day.
- D. insert the syringe into the sides of the mouth.
Correct Answer: B
Rationale: Suctioning the nose first prevents pushing secretions further down the throat.
For which condition should the nurse immediately
- A. Applying her peri-pad from back to front with notify the health care team?
- B. Periodic breathing in the newborn lasting
- C. Using the peri-bottle to rinse her perineum after approximately 3 to 5 seconds
- D. Blood sugar recording of 60 mg/dL in an infant born 6 hours ago
Correct Answer: D
Rationale: A blood sugar recording of 60 mg/dL in an infant born 6 hours ago requires immediate notification of the health care team. This low blood sugar level, also known as hypoglycemia, is a critical concern in newborns as it can lead to serious complications if not promptly addressed. Infants are particularly vulnerable to hypoglycemia due to their limited glycogen stores and high metabolic demands, which can result in inadequate glucose production. Immediate intervention and close monitoring by the healthcare team are essential to prevent potential long-term neurological consequences associated with hypoglycemia in newborns.
The nurse is teaching a prenatal class about breastfeeding. What is a key benefit of colostrum?
- A. It increases the baby’s birth weight.
- B. It provides antibodies that protect against infection.
- C. It eliminates the need for formula supplementation.
- D. It reduces maternal fatigue.
Correct Answer: B
Rationale: Colostrum is rich in antibodies, which provide passive immunity and protect the newborn from infections.
During the first few minutes after birth which physiologic changes occurs in the newborn as response to vascular pressure changes in increased oxygen levels?
- A. Dilation of pulmonary vessel (dilation of pulmonary vessels occurs in response to increased oxygen levels)
Correct Answer: A
Rationale: Immediately after birth, as the newborn takes its first breaths and transitions to breathing air, there is a rapid increase in oxygen levels in the blood. This sudden increase in oxygen causes the pulmonary vessels in the newborn's lungs to dilate. This dilation helps improve blood flow through the lungs, allowing for efficient exchange of oxygen and carbon dioxide. The dilation of pulmonary vessels is a normal physiologic response to the changing environment in the newborn's body after birth.