Nokea
The nurse is reinforcing education to a group of parents about ways to decrease the risk of sudden infant death syndrome. Which of the following recommendations should the nurse suggest? Select all that apply.
- A. Breastfeeding the infant
- B. Cosleeping with the infant in the parent's bed
- C. Giving the infant a pacifier at bedtime
- D. Maintaining a smoke-free environment
- E. Placing the infant to sleep in a side-lying position
Correct Answer: A,C,D
Rationale: Breastfeeding, pacifier use, and a smoke-free environment reduce SIDS risk. Cosleeping and side-lying positions increase risk.
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Which of the following laboratory values requires immediate follow-up?
- A. phenytoin level of 8 mcg/mL (32 mcmol/L) for a client who is receiving enteral feedings
- B. digoxin level of 1.3 ng/mL (1.7 nmol/L) for a client who has a heart rate of 62/min
- C. lithium level of 0.8 mEq/L (0.8 mmol/L) for a client who is reporting a decreased appetite
- D. International normalized ratio (INR) of 3 for a client who has a prosthetic aortic valve
Correct Answer: A
Rationale: Phenytoin levels of 8 mcg/mL are subtherapeutic (therapeutic range: 10-20 mcg/mL), especially with enteral feedings that reduce absorption, requiring immediate adjustment.
While caring for a client with a pulmonary embolus, the nurse notes several petechiae on his chest and abdomen. Which action should the nurse take first?
- A. Apply ice packs to the area.
- B. Record the finding in the client's chart.
- C. Report the finding to the physician.
- D. Monitor the finding.
Correct Answer: C
Rationale: Petechiae may indicate a coagulopathy or emboli-related complication, requiring prompt reporting to the physician for further evaluation. Recording and monitoring are secondary, and ice packs are inappropriate.
The nurse is planning care for a 6-month-old client admitted with bacterial meningitis. Which nursing action is the priority?
- A. Apply padding to the crib side rails
- B. Document head circumference daily
- C. Implement a low-stimuli environment
- D. Initiate antibiotic therapy as prescribed
Correct Answer: D
Rationale: Prompt antibiotic therapy is critical to treat bacterial meningitis and prevent complications or death, making it the priority. A, B, and C are important but secondary; padding prevents injury, daily head circumference monitors for hydrocephalus, and a low-stimuli environment reduces seizure risk, but none address the infection directly.
The nurse has just received report on 4 clients. Which of the following reported information is the most concerning?
- A. Client on a heparin drip with an activated PTT of 60 seconds
- B. Client reporting back pain 1 hour following coronary angiography
- C. Client with a head injury and a Glasgow Coma Scale score of 14
- D. Client with incisional pain rated as 6 on a scale of 0-10, two days after coronary artery bypass graft
Correct Answer: B
Rationale: Back pain shortly after coronary angiography may indicate retroperitoneal bleeding, a life-threatening complication requiring immediate investigation. The other conditions are less acute or expected.
The LPN on a medical unit observes a coworker taking diazepam ordered for a client. What should the nurse do initially?
- A. Immediately call the supervisor
- B. Confront the nurse
- C. Observe the nurse for unsafe behavior
- D. Administer that nurse's medications for the rest of the shift
Correct Answer: C
Rationale: Observing for unsafe behavior assesses immediate risk to patients, allowing appropriate reporting if impairment is confirmed.