Nokea
The nurse teaches a new mother that neonatal weight loss in the first 3 days of life is most often the result of:
- A. Allergy to formula
- B. a hypoglycemic response
- C. Inadequate breast or formula feeding
- D. Excretion of fluid via lungs, urinary bladder and bowels.
Correct Answer: D
Rationale: Fluid loss is the primary cause of early weight loss.
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The nurse is assessing a client at 28 weeks' gestation with gestational diabetes. What complication is the client at greatest risk for?
- A. Preterm labor.
- B. Placenta previa.
- C. Macrosomia.
- D. Abruptio placentae.
Correct Answer: C
Rationale: Gestational diabetes increases the risk of fetal macrosomia, which can complicate delivery.
What response should the nurse make first to a young woman who showered after a sexual assault?
- A. The evidence kit may still reveal important information.
- B. It was important for you to do that for yourself.
- C. Have you washed your clothes? If not, we might be able to obtain evidence from them.
- D. Do you remember what happened? If not, someone may have put a drug in your drink.
Correct Answer: A
Rationale: Preserving evidence is critical for legal proceedings.
The nurse is caring for a 2-week-old girl with a metabolic disorder. Which activity would deviate from the characteristics of family-centered care?
- A. Softening unpleasant information or prognoses
- B. Evaluating and changing the nursing plan of care
- C. Collaborating with the child and family as equals
- D. Showing respect for the family's beliefs and wishes
Correct Answer: A
Rationale: Family-centered care requires that the nurse provide open and honest information to the child and family. It is inappropriate to soften unpleasant information or prognoses.
Which assessment finding indicates a complication in a client attempting a VBAC?
- A. Complaint of pain between the scapula (could be uterine
- C. Contraction every 3 minutes lasting 70 seconds
- D. Pain level 6 at acme of
Correct Answer: C
Rationale: A client attempting a Vaginal Birth After Cesarean (VBAC) is at higher risk for uterine rupture. A concerning assessment finding in this scenario would be the occurrence of contractions every 3 minutes that are lasting 70 seconds. This pattern of contractions could potentially indicate uterine hyperstimulation, which increases the risk of uterine rupture. It is essential to closely monitor these contractions and address any signs of distress or complications promptly to ensure the safety of both the mother and the baby.
What contraceptive method is best suited for a single, perimenopausal woman with four sex partners who smokes 1 pack of cigarettes per day?
- A. Male condom.
- B. Intrauterine device.
- C. NuvaRing.
- D. Oral contraceptives.
Correct Answer: A
Rationale: Male condoms provide dual protection against pregnancy and STIs.