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What does the nursing process describe?
- A. what nurses do
- B. how nurses think
- C. where nurses provide care
- D. who nurses care for
Correct Answer: B
Rationale: The nursing process describes how nurses think and approach patient care. It is a systematic problem-solving approach that nurses use to provide individualized patient care. The nursing process consists of five main steps: assessment, diagnosis, planning, implementation, and evaluation. Through this process, nurses gather information, identify patient problems, set goals, implement interventions, and evaluate outcomes. By following the nursing process, nurses can deliver holistic and effective care to their patients.
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is a vitamin supplement prescribed for clients who have hyperemesis gravidarum.
- A. INCORRECT: Ferrous sulfate is a medication used in the treatment of iron deficiency anemia.
- B. CORRECT: Calcium gluconate is the antidote for magnesium sulfate. the baby is inside. What is the nurse9s best response?
- C. "Your baby's umbilical cord is surrounded by connective tissue called Wharton jelly, which prevents compression of the blood vessels and ensures continued nourishment of your baby."
Correct Answer: B
Rationale: Calcium gluconate is indeed the antidote for magnesium sulfate toxicity. In cases where a pregnant client is receiving magnesium sulfate for conditions like preeclampsia, it is important to have calcium gluconate readily available in case of magnesium toxicity. This is a crucial intervention to prevent any adverse effects on both the mother and the baby. So, the nurse should ensure that calcium gluconate is available and be prepared to administer it if needed.
Why is it important to consider special considerations, such as age, cultural background, or specific health conditions, during a health history for a well-person exam?
- A. to tailor the examination and screening tests to the individual’s health needs
- B. to assess the risk of occupational and environmental exposures
- C. to determine the individual's immunization history
- D. to identify potential safety considerations, such as intimate partner violence or mental abuse
Correct Answer: A
Rationale:
Which action is the most appropriate nursing measure when a baby has an unexpected defect at birth?
- A. Remove the baby from the delivery area immediately.
- B. Inform the parents immediately that something is wrong.
- C. Tell the parents that the baby has to go to the nursery immediately.
- D. Explain the defect and show the baby to the parents as soon as possible.
Correct Answer: D
Rationale: When a baby is born with an unexpected defect, it is crucial for the nursing staff to explain the defect to the parents and show the baby to them as soon as possible. This approach allows for open communication, transparency, and the opportunity for the parents to start processing the situation emotionally. By involving the parents and keeping them informed, trust and understanding can be established between the healthcare providers and the family, ultimately fostering a supportive environment for everyone involved in the care of the baby. It is essential to approach the situation with empathy and sensitivity while providing the necessary information to the parents.
A nurse is assessing a newborn who was born vaginally with vacuum extractor assistance ... that crosses the suture line. The nurse should identify the swellings as which of the following....?
- A. Nevus flammeus
- B. Caput uccedaneum
- C. Cephalohematoma
- D. Erythema toxicum
Correct Answer: C
Rationale: Cephalohematoma is a collection of blood between the skull and its periosteum that occurs due to rupture of blood vessels during birth trauma. It is typically found on one side of the head and does not cross the suture line. In contrast, caput succedaneum is a diffuse swelling that occurs on the newborn's scalp and can cross the suture lines. Nevus flammeus is a vascular birthmark that appears as a pink or red patch on the skin, unrelated to trauma. Erythema toxicum is a benign rash that appears as red spots or patches with a white or yellow papule in the center, also unrelated to trauma.
The nurse is assessing a client with suspected gestational diabetes. What is the most reliable diagnostic test?
- A. Random blood glucose test.
- B. Oral glucose tolerance test (OGTT).
- C. Fasting blood glucose test.
- D. Hemoglobin A1C.
Correct Answer: B
Rationale: The oral glucose tolerance test (OGTT) is the standard for diagnosing gestational diabetes.