Nokea
The nurse is teaching parents of a newborn about feeding their infant. Which of the following instructions should the nurse include?
- A. Use the defrost setting on microwave ovens to warm bottles.
- B. When refrigerating formula, don't feed the baby partially used bottles after 24 hours.
- C. When using formula concentrate, mix two parts water and one part concentrate.
- D. If a portion of one bottle is left for the next feeding, go ahead and add new formula to fill it.
Correct Answer: A
Rationale: Parents must be careful when warming bottles in a microwave oven because the milk can become superheated. When a microwave oven is used, the defrost setting should be chosen, and the temperature of the formula should be checked before giving it to the baby. Refrigerated, partially used bottles should be discarded after 4 hours because the baby might have introduced some pathogens into the formula. Returning the bottle to the refrigerator does not destroy pathogens. Formula concentrate and water are usually mixed in a 1:1 ratio of one part concentrate and one part water. Infants should be offered fresh formula at each feeding. Partially used bottles should not have fresh formula added to them. Pathogens can grow in partially used bottles of formula and be transferred to the new formula.
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The acts enacted by states to provide immunity from liability to persons who provide emergency care at an accident scene are called:
- A. Good Samaritan laws.
- B. HIPAA.
- C. Patient Self-Determination Act (PSDA).
- D. OBRA.
Correct Answer: A
Rationale: The Good Samaritan laws protect providers of care in an emergency situation. HIPAA's focus is confidentiality of information and right to privacy. The PSDA concerns a client's autonomous decision-making. OBRA was passed in the late 1980s to promote nursing home reform due to quality issues.
This is an example of:
- A. professional nurturing.
- B. networking.
- C. mentoring.
- D. collegiality.
Correct Answer: B
Rationale: Networking involves the process of developing and using contacts throughout one's professional career for information, advice, and support. Nurturing and mentoring are both examples of assistance to other colleagues in formal and informal relationships for support and career building. Collegiality is the professional camaraderie or rapport established among persons through shared experiences.
Which of the following is most likely to impact the body image of an infant newly diagnosed with Hemophilia?
- A. immobility
- B. altered growth and development
- C. hemarthrosis
- D. altered family processes
Correct Answer: D
Rationale: Altered Family Processes is a potential nursing diagnosis for the family and client with a new diagnosis of Hemophilia. Infants are aware of how their caregivers respond to their needs. Stresses can have an immediate impact on the infant's development of trust and how others relate to them because of their diagnosis. The long-term effects of hemophilia can include problems related to immobility. Altered growth and development could not have developed in a newly diagnosed client. Hemarthrosis is acute bleeding into a joint space that is characteristic of hemophilia. It does not have an immediate effect on the body image of a newly diagnosed hemophiliac.
The advanced directive in a client's chart is dated August 12, 1998. The client's daughter produces a Power of Attorney for Health Care, dated 2003, which contains different care direction(s). The nurse is supposed to:
- A. follow the 1998 version because it's part of the legal chart.
- B. follow the 1998 version because the physician's code order is based on it.
- C. follow the 2003 version, place it in the chart, and communicate the update appropriately.
- D. follow neither until clarified by the unit manager.
Correct Answer: C
Rationale: The document dated 2003 supersedes the previous version and should be used as a basis for care direction. Choices 1 and 2 are incorrect because the 1998 version is now outdated. Choice 4 is incorrect because the nurse can be held negligent for not responding to the 2003 document as directed.
An LPN is working on the care plan for a client with diabetes mellitus. Which of these outcomes would be the most appropriate?
- A. The client will maintain a blood glucose level within the normal range of 70-110 (per facility policy).
- B. The client will maintain a blood glucose level within normal range limits today.
- C. The client will maintain a blood glucose level within the normal range of 70-110 (per facility policy) throughout my shift.
- D. The client will maintain a blood glucose level within normal limits throughout my shift.
Correct Answer: C
Rationale: Outcomes in nursing care plans should be objective, obtainable, observable, and measurable.