Nokea
The nurse is functioning in the primary role to care for a 12-year-old boy with metastatic cancer in the liver. Which activity is typical of advocacy?
- A. Instructing parents about proper home care
- B. Educating the family about choices they have
- C. Telling parents about clinical guidelines
- D. Teaching the family about types of cancers
Correct Answer: B
Rationale: Educating the family about choices they have regarding therapies for the cancer in the child's liver is an example of advocacy, in which the nurse advances the interests of the child and family by informing them of options and assisting them to make informed decisions.
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A neonate is being discharged home with a fiber-optic blanket for treatment of physiologic jaundice. What is important for the nurse to include in the discharge instructions?
- A. Cover the infant's eyes during the treatment.
- B. Reduce the daily number of formula feedings.
- C. Encourage frequent feeding to increase intake.
- D. Expect a constipated stool until jaundice clears.
Correct Answer: C
Rationale: Frequent feeding aids in bilirubin excretion.
A nurse is assessing a client who is at 31 weeks of gestation. Which of the following findings show potential prenatal complication?
- A. Periodic tingling of fingers
- B. Absence of clonus
- C. Leg cramps
- D. Blurred vision
Correct Answer: D
Rationale: Blurred vision is a potential prenatal complication during the third trimester of pregnancy and can be a sign of conditions such as preeclampsia or gestational diabetes. It is important for the nurse to further assess this finding and consult with the healthcare provider to ensure appropriate management and monitoring of the client's condition. Periodic tingling of fingers, absence of clonus, and leg cramps are common discomforts during pregnancy and do not typically indicate a prenatal complication.
What statement by a client suggests the relationship may be in the 'honeymoon phase'?
- A. My partner said that he will never hurt me again.
- B. My partner drinks alcohol only on the weekends.
- C. My partner yells less than he used to.
- D. My partner has frequent bouts of insomnia.
Correct Answer: A
Rationale: Promises to stop abuse characterize the honeymoon phase.
What information should be included in teaching a breastfeeding woman about Seasonale (ethinyl estradiol and levonorgestrel)?
- A. The woman will menstruate every 8 to 9 weeks.
- B. The pills are taken for 3 out of every 4 weeks.
- C. Breakthrough bleeding is a common side effect.
- D. Breastfeeding is compatible with the medication.
Correct Answer: C
Rationale: Breakthrough bleeding is a known side effect of hormonal contraceptives.
The nurse's initial action when caring for an infant with a slightly decreased temperature is to:
- A. notify the physician immediately.
- B. place a cap on the infant's head and have the mother perform kangaroo care.
- C. tell the mother that the infant must be kept in the nursery and observed for the next 4 hours.
- D. change the formula, as this is a sign of formula intolerance.
Correct Answer: B
Rationale: Kangaroo care and covering the head help conserve heat.