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The nurse is evaluating the involution of a woman who is 3 days post partum. Which of the following finding would the nurse evaluate as normal?
- A. Fundus 1 cm above the umbilicus, lochia rosa.
- B. Fundus 2 cm above the umbilicus, lochia alba.
- C. Fundus 2 cm below the umbilicus, lochia rubra.
- D. Fundus 3 cm below the umbilicus, lochia serosa.
Correct Answer: D
Rationale: By day 3, the fundus should descend to 3 cm below the umbilicus, and lochia should transition to serosa.
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Transient dermatologic conditions are common in newborns. What is the term for temporary, tiny white bumps or cysts on the newborn’s skin, usually on the face around the cheek, nose, or chin area?
- A. newborn acne
- B. milia
- C. pustular melanosis
- D. erythema toxicum
Correct Answer: B
Rationale: Milia are small, harmless white bumps caused by blocked oil glands.
When the nurse determines they have a high-risk newborn and birthing person in their care, what can they do to mitigate the situation?
- A. Document in the chart.
- B. Reassure the parent that everything will be fine.
- C. Refer the couplet to social work for early intervention.
- D. Refer to a pediatric health-care provider for well-baby checkup.
Correct Answer: C
Rationale: The correct answer is C: Refer the couplet to social work for early intervention. This is the best course of action as social work can provide support and resources to address the high-risk situation. Documenting in the chart (A) is important but not sufficient for immediate intervention. Reassuring the parent (B) may be helpful, but it doesn't address the risk factor. Referring to a pediatric provider (D) is important but social work intervention can provide more comprehensive support in this specific situation.
What organization developed the CJMM?
- A. ACOG
- B. ANA
- C. AWHONN
- D. NCSBN
Correct Answer: D
Rationale: The National Council of State Boards of Nursing (NCSBN) developed the Clinical Judgment Measurement Model (CJMM).
A maculopapular rash with a red base and a small white papule in the center is commonly known as
- A. milia.
- B. Mongolian spots.
- C. erythema toxicum.
- D. CafÃ-au-lait spots.
Correct Answer: C
Rationale: The correct answer is C: erythema toxicum. This rash is characterized by red macules with small white papules in the center. Erythema toxicum is a common benign rash in newborns, usually appearing in the first few days of life. Milia (A) are tiny white bumps on the skin, Mongolian spots (B) are blue-gray birthmarks, and Café-au-lait spots (D) are flat, light brown spots. In this case, the description of a maculopapular rash with a red base and a small white papule matches the characteristics of erythema toxicum, making it the correct choice.
A premature newborn requires assistance with ventilation and oxygenation. What method of respiratory support is most likely to be utilized if the newborn requires PPV at birth and continues to need assistance?
- A. bag mask positive pressure ventilation (PPV)
- B. extracorporeal membrane oxygenation (ECMO)
- C. continuous positive airway pressure (CPAP)
- D. nasal cannula at 1 L
Correct Answer: A
Rationale: Bag-mask PPV is commonly used initially for premature infants requiring respiratory support.