Nokea
A nurse is caring for a client who is 6 weeks of gestation and reports nausea and vomiting. Which of the following recommendations should the nurse make?
- A. Avoid eating snacks before bedtime
- B. Eat high-fat snacks before getting out of bed
- C. Drink additional liquids with each meal
- D. Consume food served at cool temperatures
Correct Answer: D
Rationale: The correct answer is D: Consume food served at cool temperatures. This recommendation is appropriate because cold foods tend to have less strong odors, which can help reduce nausea in pregnant women. Additionally, cold foods are often better tolerated by individuals experiencing nausea and vomiting.
Avoiding eating snacks before bedtime (choice A) may not directly address the nausea and vomiting symptoms. Eating high-fat snacks before getting out of bed (choice B) could potentially exacerbate nausea. Drinking additional liquids with each meal (choice C) may not necessarily alleviate nausea and can sometimes worsen symptoms.
In summary, choosing cold foods (choice D) is the best recommendation as it directly targets the symptoms of nausea and vomiting in early pregnancy.
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A nurse is caring for four newborns. Which of the following newborns should the nurse assess first?
- A. newborn who has nasal flaring
- B. newborn who has subconjunctival hemorrhage of the left eye
- C. A newborn who has overlapping suture lines
- D. A newborn who has not rust-stained urine
Correct Answer: A
Rationale: The correct answer is A: newborn who has nasal flaring. Nasal flaring indicates respiratory distress, which is a priority concern in newborns as it can lead to hypoxia. The nurse should assess this newborn first to ensure adequate oxygenation.
B: Subconjunctival hemorrhage is common and not an urgent issue.
C: Overlapping suture lines are normal in newborns and do not require immediate attention.
D: Not passing rust-stained urine could indicate a metabolic issue but is not as urgent as respiratory distress.
A nurse on postpartum unit caring for four clients. Which of the following clients should receive Rh, (D) Immune globulin to prevent Rh- is immunization?
- A. An Rh-negative mother who has an Rh- positive infant
- B. An Rh –positive mother who has an Rh- negative infant
- C. An Rh-positive mother who has an Rh- positive infant
- D. An Rh- negative mother who has an Rh- negative infant
Correct Answer: A
Rationale: The correct answer is A: An Rh-negative mother who has an Rh-positive infant. This mother is at risk for developing Rh isoimmunization, a condition where her immune system attacks the Rh-positive red blood cells of her infant, potentially causing harm in future pregnancies. Rh(D) Immune globulin is given to prevent this by blocking the mother's immune response to the Rh-positive cells of the infant. The other choices do not require Rh(D) Immune globulin because they do not involve the risk of Rh isoimmunization. Choice B involves an Rh-positive mother who is not at risk of isoimmunization. Choice C involves an Rh-positive mother with an Rh-positive infant, so there is no incompatibility. Choice D involves an Rh-negative mother with an Rh-negative infant, so there is no risk of isoimmunization.
A nurse is reviewing the laboratory results for a newborn 12 hours old. Which of the following is an expected findings.
- A. Glucose 40mg/dl
- B. WBC 6000
- C. Hemoglobin 12
- D. Platelets 80000
Correct Answer: A
Rationale: The correct answer is A: Glucose 40mg/dl. In newborns, normal glucose levels range from 40-60mg/dl. This level is expected to be lower in the immediate postnatal period due to the transition from placental to independent glucose regulation. WBC count of 6000 is within normal range. Hemoglobin at 12 is normal for a newborn. Platelets of 80000 are low and could indicate a potential issue, such as thrombocytopenia, which would require further investigation.
A nurse is caring for a newborn who is 24 hr old. Which of the following Laboratory findings should the nurse report to the provider?
- A. Hgb 20 g/dL
- B. Bilirubin 2mg/dL
- C. Platelets 200 .000/mm3
- D. WBC count 32.000/mm3
Correct Answer: D
Rationale: The correct answer is D: WBC count 32,000/mm3. A newborn with a WBC count of 32,000/mm3 indicates a potential infection, as newborns typically have a higher WBC count initially due to stress of birth. It is important to report this finding to the provider for further evaluation and possible treatment. Choices A, B, and C are within normal range for a 24-hour-old newborn, so they do not require immediate reporting. Choice D, Hgb 20 g/dL, is not a typical laboratory finding for a newborn and would require further investigation, but it is not as urgent as a high WBC count indicating infection.
A nurse is assessing a client during her first prenatal visit. The client reports March 20th as her last menstrual period. Use Nagele's rule to calculate the estimated date of delivery.
- A. 03/20
- B. 12/27
- C. 11/27
- D. 10/03
Correct Answer: B
Rationale: The correct answer is B: 12/27. Nagele's rule calculates the estimated due date by adding 7 days to the first day of the last menstrual period, then subtracting 3 months and adding 1 year. In this case, March 20th + 7 days = March 27th. Subtracting 3 months gives us December 27th. Adding 1 year, we get December 27th of the current year as the estimated due date. Choice A is incorrect because it does not follow Nagele's rule. Choice C is incorrect as it is not 3 months subtracted from the reported last menstrual period. Choice D is incorrect as it does not account for the necessary adjustments according to Nagele's rule.