Nokea
What is the priority nursing intervention for a newborn with a low Apgar score of 4 at 1 minute?
- A. Place the baby in skin-to-skin contact with the mother
- B. Administer oxygen and stimulate the baby
- C. Delay interventions and reassess in 5 minutes
- D. Begin chest compressions immediately
Correct Answer: B
Rationale: A low Apgar score indicates poor adaptation; oxygen improves function.
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The nurse is monitoring a client in labor. The nurse suspects umbilical cord compression if which is noted on the external monitor tracing during a contraction?
- A. Variability
- B. Accelerations
- C. Early decelerations
- D. Variable decelerations
Correct Answer: D
Rationale: Variable decelerations are a hallmark sign of umbilical cord compression, requiring immediate monitoring and intervention.
Which aspect of client wellness has not been a focus of health during the 21st century ?
- A. Disease prevention
- B. Health promotion
- C. Wellness
- D. Analysis of morbidity and mortality
Correct Answer: D
Rationale: The focus on health has shifted to disease prevention, health promotion, and wellness. In the last century, much of the focus was on analyzing morbidity and mortality rates.
The nurse is teaching a prenatal class about breastfeeding. What is a key benefit of colostrum?
- A. It increases the baby’s birth weight.
- B. It provides antibodies that protect against infection.
- C. It eliminates the need for formula supplementation.
- D. It reduces maternal fatigue.
Correct Answer: B
Rationale: Colostrum is rich in antibodies, which provide passive immunity and protect the newborn from infections.
The primiparous patient that's 40 weeks' gestation reports to the nurse that she has increased pelvic pressure and increased urinary frequency. Which response by the nurse is best?
- A. This symptom usually means the baby's head has descended further
- B. Unless you have pain with urination, we don't need to worry it
- C. Come in for an appointment today and we'll check out everything
- D. This might indicate that the baby is no longer in a head down position
Correct Answer: A
Rationale: The best response by the nurse is to reassure the primiparous patient that her increased pelvic pressure and urinary frequency could mean that the baby's head has descended further into the pelvis. This can indicate that labor is approaching, as the baby is getting into position for birth. It is important for the nurse to provide this information to ease the patient's concerns and help her understand the potential significance of these symptoms at 40 weeks' gestation.
In teaching parents to use a bulb syringe to suction an infant, the nurse should teach them to:
- A. suction the back of the throat vigorously.
- B. always suction the nose before suctioning the mouth.
- C. use it only once a day.
- D. insert the syringe into the sides of the mouth.
Correct Answer: B
Rationale: Suctioning the nose first prevents pushing secretions further down the throat.