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What should nursing care of an infant with oral candidiasis (thrush) include?
- A. Avoid use of a pacifier.
- B. Continue medication for the prescribed number of days.
- C. Remove the characteristic white patches with a soft cloth.
- D. Apply medication to the oral mucosa, being careful that none is ingested.
Correct Answer: B
Rationale: The medication must be continued for the prescribed number of days. To prevent relapse, therapy should continue for at least 2 days after the lesions disappear. Pacifiers can be used. The pacifier should be replaced with a new one or boiled for 20 minutes once daily. One of the characteristics of thrush is that the white patches cannot be removed. The medication is applied to the oral mucosa and then swallowed to treat Candida albicans infection in the gastrointestinal tract.
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Which intervention may decrease the incidence of physiologic jaundice in a healthy full-term infant?
- A. Institute early and frequent feedings.
- B. Bathe newborn when the axillary temperature is 36.3 C (97.5 F).
- C. Place the newborns crib near a window for exposure to sunlight.
- D. Suggest that the mother initiate breastfeeding when the danger of jaundice has passed.
Correct Answer: A
Rationale: Physiologic jaundice is caused by the immature hepatic function of the newborns liver coupled with the increased load from red blood cell hemolysis. The excess bilirubin from the destroyed red blood cells cannot be excreted from the body. Feeding stimulates peristalsis and produces more rapid passage of meconium. Bathing does not affect physiologic jaundice. Placing the newborns crib near a window for exposure to sunlight is not a treatment of physiologic jaundice. Colostrum is a natural cathartic that facilitates meconium excavation.
The nurse is planning care for an infant receiving calcium gluconate for treatment of hypocalcemia. Which route of administration should be used?
- A. Oral
- B. Intramuscular
- C. Intravenous
- D. Intraosseous
Correct Answer: C
Rationale: Calcium gluconate is administered intravenously over 10 to 30 minutes or as a continuous infusion. If it is given more rapidly than this, cardiac dysrhythmias and circulatory collapse may occur. Early feedings are indicated, but when the ionized calcium drops below 3.0 to 4.4 mg/dL, intravenous calcium gluconate is necessary. Intramuscular or intraosseous administration is not recommended.
What is an infant with severe jaundice at risk for developing?
- A. Encephalopathy
- B. Bullous impetigo
- C. Respiratory distress
- D. Blood incompatibility
Correct Answer: A
Rationale: Unconjugated bilirubin, which can cross the blood-brain barrier, is highly toxic to neurons. An infant with severe jaundice is at risk for developing kernicterus or bilirubin encephalopathy. Bullous impetigo is a highly infectious bacterial infection of the skin. It has no relation to severe jaundice. A blood incompatibility may be the causative factor for the severe jaundice.
A woman who is Rh-negative is pregnant with her first child, and her husband is Rh positive. During her 12-week prenatal visit, she tells the nurse that she has been told that this is dangerous. What should the nurse tell her?
- A. That no treatment is necessary
- B. That an exchange transfusion will be necessary at birth
- C. That no treatment is available until the infant is born
- D. That administration of Rh immunoglobulin is indicated at 26 to 28 weeks of gestation
Correct Answer: D
Rationale: The goal is to prevent isoimmunization. If the mother has not been previously exposed to the Rh-negative antigen, Rh immunoglobulin (RhIg) is administered at 26 to 28 weeks of gestation and again within 72 hours of birth. The intramuscular administration of RhIg has virtually eliminated hemolytic disease of the infant secondary to the Rh factor. Unless other problems coexist, the newborn will not require transfusions at birth.
Rh hemolytic disease is suspected in a mothers second baby, a son. Which factor is important in understanding how this could develop?
- A. The first child was a girl.
- B. The first child was Rh positive.
- C. Both parents have type O blood.
- D. She was not immunized against hemolysis.
Correct Answer: B
Rationale: Hemolytic disease of the newborn results from an abnormally rapid rate of red blood cell (RBC) destruction. The major causes of this are maternal-fetal Rh and ABO incompatibility. If an Rh-negative mother has previously been exposed to Rh-positive blood through pregnancy or blood transfusion, antibodies to this blood group antigen may develop so that she is isoimmunized. With further exposure to Rh-positive blood, the maternal antibodies agglutinate with the RBCs of the fetus that has the antigen and destroy the cells. Hemolytic disease caused by ABO incompatibilities can be present with the first pregnancy. The gender of the first child is not a concern. Blood type is the important consideration. If both parents have type O blood, ABO incompatibility should not be a possibility.