Nokea
The nurse is reviewing the prescriptions to determine priorities. Which prescriptions take priority?
- A. Bolus of 2 ml/kg glucose 10% IV.
- B. Feed immediately.
- C. Echocardiogram.
- D. Monitor for respiratory distress.
- E. Apply dextrose gel inside the baby's cheek.
Correct Answer: E
Rationale: Applying dextrose gel is a rapid, non-invasive way to treat hypoglycemia, prioritizing immediate glucose stabilization in a jittery newborn.
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History and Physical:
Laboratory Results:
The client is a 24-year-old pregnant woman. She is gravida 2, para 1 (G2P1). Her mother has a history of type 2 diabetes mellitus.
Which is likely causing this client's increased blood glucose at 28 weeks? Select all that is apply.
- A. Fetal health problems
- B. Decreased cortisol
- C. Increased insulin needs
- D. Placental infection
- E. Normal weight gain of pregnancy
- F. Fetus with macrosomia
Correct Answer: C,E,F
Rationale: Increased insulin needs, normal weight gain, and macrosomia contribute to insulin resistance and hyperglycemia in pregnancy, unlike fetal health issues, decreased cortisol, or placental infection.
What instructions should the nurse provide to a new mother regarding postpartum care and monitoring the newborn's health?
- A. You will need to set up an appointment with your obstetrician in 8 weeks.
- B. You will need to abstain from sexual activities untilå½¼æ¤, and until you see your obstetrician.
- C. Contact the pediatrician if the baby is not breastfeeding well or has fewer wet diapers and stools.
- D. The lactation nurse will be coming by to work with you and your baby.
Correct Answer: C
Rationale: Monitoring breastfeeding success and diaper output is critical for detecting newborn health issues like dehydration, unlike incorrect obstetrician visit timing or less comprehensive lactation support.
The nurse reports the current assessment findings to the healthcare provider (HCP). Based on the assessment findings, the priority diagnosis suspected is preeclampsia. This diagnosis places the client at risk of which complications?
- A. Seizures.
- B. Stroke.
- C. Organ damage.
- D. Preterm birth.
Correct Answer: A,B,C,D
Rationale: Preeclampsia increases risks of seizures (eclampsia), stroke, organ damage (liver/kidneys), and preterm birth due to placental insufficiency.
A client who is positive for Neisseria gonorrhoeae vaginally delivered a newborn. Which medication should the nurse administer to the newborn?
- A. Erythromycin ointment.
- B. Neomycin ointment.
- C. Tetracaine eye drops.
- D. Latanoprost eye drops.
Correct Answer: A
Rationale: Erythromycin ointment prevents ophthalmia neonatorum from Neisseria gonorrhoeae, protecting the newborn's eyes from infection.
Which action should the nurse take?
- A. Document the normal finding.
- B. Notify the healthcare provider.
- C. Schedule an ultrasound.
- D. Obtain hematocrit level.
Correct Answer: B
Rationale: Notifying the healthcare provider about abnormal FHR patterns ensures timely intervention to address potential fetal distress.