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.
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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.
What is the nurse's best response?
- A. The light increases the infant's metabolism.'
- B. The light stimulates liver function.'
- C. The light dilates blood vessels.'
- D. The light breaks down bilirubin.'
Correct Answer: D
Rationale: Phototherapy breaks down excess bilirubin to prevent kernicterus, allowing it to be excreted.
Which statement indicates that parents understand how to feed their infant who had a surgical repair for a cleft lip?
- A. We are feeding the baby with a dropper for 2 weeks.'
- B. We resumed bottle feeding after discharge.'
- C. We started the baby on solid food yesterday.'
- D. The baby is drinking well from a straw.'
Correct Answer: A
Rationale: The infant is fed with a dropper until the cleft lip incision is completely healed, about 1 to 2 weeks after surgery.
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.
What characteristics are typical in a child diagnosed with Down syndrome?
- A. Close-set eyes
- B. Simian creases
- C. Wide-spaced front teeth
- D. Protruding tongue
- E. Curved, small fingers
Correct Answer: A,B,D,E
Rationale: Children with Down syndrome have close-set upturned eyes, simian creases, protruding tongue, and curved, small fingers.
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