Nokea
The nurse is preparing new parents for discharge with their newborn. The father asks the nurse why the baby's head is so pointed and puffy-looking. What is the best response by the nurse?
- A. His head is molded from fitting through the birth canal. It will become more round.
- B. We refer to that as 'cone head,' which is a temporary condition that goes away.
- C. It might mean that your baby sustained brain damage during birth, and could have delays.
- D. I think he looks just like you. Your head is much the same shape as your baby's.
Correct Answer: A
Rationale: The corrected response 'His head is molded from fitting through the birth canal. It will become more round.' is the best answer as it explains the physiological reason for the baby's appearance after birth. It reassures the father that the pointed and puffy-looking head is a normal part of the birthing process and will resolve on its own. Choice B is incorrect because while 'cone head' is a term used colloquially, it does not provide a detailed explanation. Choice C is incorrect and should be avoided as it introduces unnecessary worry by suggesting brain damage. Choice D is not an appropriate response as it doesn't address the father's concern or provide accurate information about newborn physiology.
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The student nurse has performed a gestational age assessment of an infant and finds the infant to be at 32 weeks. On which set of characteristics is the nurse basing this assessment?
- A. Lanugo mostly gone, little vernix remaining on the body
- B. Prominent clitoris, enlarging labia minora, patent anus
- C. Full areola, 5 to 10 mm nipple bud, pinkish-brown areola
- D. Skin opaque, cracking at wrists and ankles, no visible vessels
Correct Answer: B
Rationale: The correct answer is B. At 30 to 32 weeks' gestation, the clitoris is prominent, and the labia minora are enlarging. The labia majora are small and widely separated. As gestational age increases, the labia majora increase in size. At 36 to 40 weeks, they almost cover the clitoris. At 40 weeks and beyond, the labia majora cover the labia minora and clitoris. Choices A, C, and D do not align with the characteristic features seen at 32 weeks of gestation, making them incorrect.
During the initial assessment of the newborn, which of the following data would be considered normal?
- A. Chest circumference 31.5 cm, head circumference 33.5 cm
- B. Chest circumference 30 cm, head circumference 29 cm
- C. Chest circumference 38 cm, head circumference 31.5 cm
- D. Chest circumference 32.5 cm, head circumference 36 cm
Correct Answer: A
Rationale: The correct answer is A. During the initial assessment of a newborn, the average head circumference at birth is 32 to 37 cm, while the average chest circumference ranges from 30 to 35 cm. Normally, the head's circumference is about 2 cm greater than the chest circumference at birth. Choice A provides measurements of chest circumference 31.5 cm and head circumference 33.5 cm, both falling within the normal range in terms of actual size and relative size. Choices B, C, and D do not align with the typical measurements seen in a healthy newborn. Choice B has both circumferences below the average range, choice C has the chest circumference above the average, and choice D has the head circumference notably higher than the chest circumference, which is not typical for a newborn.
Which of the following is NOT a function of hormones?
- A. Producing new offspring
- B. Promoting growth and beauty
- C. Maintaining body temperature
- D. Fighting infections
Correct Answer: A
Rationale: Hormones play various roles in the body, such as promoting growth and beauty, maintaining body temperature, and fighting infections. However, producing new offspring is not a direct function of hormones. Reproduction is primarily regulated by other factors like the reproductive system. Choice B is incorrect because hormones can indeed influence growth but not specifically 'beauty.' Choice C is incorrect as hormones can help regulate body temperature indirectly. Choice D is incorrect as hormones like cytokines can be involved in the body's immune response to fight infections.
A breastfeeding mother reports breast engorgement. The nurse advises her to:
- A. Increase the frequency of feedings
- B. Apply ice packs to the breasts
- C. Avoid breastfeeding until the pain subsides
- D. Use a breast pump to empty the breasts completely
Correct Answer: A
Rationale: Breast engorgement occurs when the breasts become overfilled with milk. By increasing the frequency of feedings, the mother can ensure that her breasts are emptied regularly, helping to relieve the discomfort associated with engorgement. This advice promotes effective milk removal and prevents further accumulation, which can worsen the condition. Applying ice packs may provide temporary relief, but it does not address the underlying issue of milk accumulation. Avoiding breastfeeding can lead to further engorgement and potential complications. Using a breast pump to empty the breasts completely may be necessary in some cases, but increasing the frequency of feedings is the initial and most appropriate intervention to manage breast engorgement.
Non-pharmacological techniques can help lower blood pressure. Which of the following is not considered one of these types of techniques?
- A. Dietary changes
- B. Multivitamins
- C. Smoking cessation
- D. Limiting caffeine
Correct Answer: B
Rationale: Multivitamins are not typically considered a non-pharmacological technique for lowering blood pressure. While dietary changes, smoking cessation, and limiting caffeine intake can positively impact blood pressure levels, multivitamins are generally not specifically recommended as a primary intervention for this purpose. Dietary changes can include reducing salt intake and increasing potassium-rich foods, which are known to help manage blood pressure. Smoking cessation is crucial due to the negative impact of smoking on blood pressure and overall cardiovascular health. Limiting caffeine intake is advised as excessive caffeine consumption can lead to a temporary increase in blood pressure. Therefore, focusing on lifestyle modifications like healthy eating, smoking cessation, and caffeine reduction is more effective in managing blood pressure than relying on multivitamins.