Nokea
What is the most appropriate nursing action for the infant having phototherapy?
- A. Cover the infant's head with a hat.
- B. Dress the infant lightly in a T-shirt.
- C. Keep the infant's eyes covered.
- D. Reposition the infant at least every 4 to 8 hours.
Correct Answer: C
Rationale: The infant's eyes are protected with patches during phototherapy to prevent damage from high-intensity lights.
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What assessment findings can the nurse anticipate?
- A. High blood glucose levels
- B. Weight of 9 pounds or more
- C. Decreased subcutaneous fat
- D. Hypocalcemia
- E. Hyperbilirubinemia
Correct Answer: B,D,E
Rationale: Macrosomic newborns of diabetic mothers often weigh over 9 pounds and are prone to hypocalcemia and hyperbilirubinemia due to metabolic changes.
The nurse knows that what is the usual treatment for an infant with this diagnosis?
- A. A Pavlik harness
- B. A body spica cast
- C. Traction
- D. Triple-diapering
Correct Answer: A
Rationale: For infants over 2 months with developmental hip dysplasia, a Pavlik harness is used for longer-term immobilization.
What would the nurse include when instructing parents about positioning their toddler who has just had a body spica cast applied?
- A. Prop the child upright with pillows for meals.
- B. Use the bar between the legs to turn the child.
- C. Put the child on her abdomen to sleep.
- D. Change the child's position frequently.
Correct Answer: D
Rationale: Frequent position changes relieve pressure and promote circulation in a toddler with a body spica cast.
What scenario indicates this patient will require RhoGAM administration?
- A. She has had one Rh-negative child and is pregnant with an Rh-negative child.
- B. She has had an Rh-positive infant and is pregnant with an Rh-positive fetus.
- C. She has had an O-negative child and is pregnant with a B-negative child.
- D. She is a primipara with an O-negative child.
Correct Answer: B
Rationale: An Rh-negative mother who has had an Rh-positive child and is pregnant with another Rh-positive fetus requires RhoGAM to prevent antibody formation.
What should they be instructed to provide special attention to in regard to the generalized hypotonicity of the child?
- A. Preventing hyperthermia
- B. Respiratory care
- C. Prevention of diarrhea
- D. Incontinence care
Correct Answer: B
Rationale: Generalized hypotonicity in Down syndrome causes mucus accumulation, increasing the risk of respiratory problems.