Nokea
A nurse is assisting in planning care for a newborn who is experiencing neonatal abstinence syndrome.
Which of the following actions should the nurse recommend?
- A. Avoid swaddling the newborn
- B. Minimize holding the newborn
- C. Decrease environmental noise.
- D. Avoid using a pacifier.
Correct Answer: C
Rationale: Decreasing environmental noise reduces stress and overstimulation in newborns with neonatal abstinence syndrome, who are hypersensitive, aiding comfort and stability.
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A nurse is checking the reflexes of a newborn.
Which of the following actions should the nurse use to elicit the Babinski reflex?
- A. Touch the corner of the newborn's mouth.
- B. Place the newborn supine and apply pressure to the soles of the feet.
- C. Stroke upward on the lateral aspect of the sole of the newborn's foot
- D. Pull the newborn up by the wrist from a supine position.
Correct Answer: C
Rationale: Stroking upward on the lateral sole elicits the Babinski reflex, where toes fan and extend, a normal newborn response indicating neurological health.
A nurse is reinforcing teaching with a client about various contraceptive methods. Which of the following statements should the nurse include in the teaching?
- A. You will need to receive a medroxyprogesterone acetate injection once per month.
- B. Combined estrogen-progestin contraceptive pills cause longer periods.
- C. Oral contraceptives decrease the risk for endometrial cancer.
- D. You will need to have your diaphragm replaced every 4 years.
Correct Answer: C
Rationale: Oral contraceptives, particularly combined ones, decrease endometrial cancer risk, an important benefit to include in teaching about contraception.
A nurse is contributing to the plan of care for a newborn who requires phototherapy for hyperbilirubinemia.
Which of the following interventions should the nurse recommend including in the plan?
- A. Reposition the newborn every 2 to 3 hr.
- B. Monitor the newborn's blood glucose level every 2 hr.
- C. Give the newborn 30 ml of distilled water after each feeding.
- D. Apply a water-based ointment to the newborn's skin every 4 to 6 hr.
Correct Answer: A
Rationale: Repositioning the newborn every 2 to 3 hours helps ensure uniform exposure to the phototherapy lights, maximizing the effectiveness of the treatment. This prevents uneven distribution of light and reduces the risk of pressure ulcers or skin breakdown from prolonged immobility.
A nurse is caring for a client who is pregnant and has a vaginal culture that is positive for chlamydia.
Which of the following medications should the nurse plan to administer?
- A. Acyclovir
- B. Metronidazole
- C. Tetracycline
- D. Amoxicillin
Correct Answer: D
Rationale: Amoxicillin is a safe and effective antibiotic for treating chlamydia in pregnant women, avoiding tetracyclines which are contraindicated due to fetal risks.
A nurse is reinforcing teaching about breastfeeding with a client who is postpartum.
Which of the following statements by the client indicates an understanding of the teaching?
- A. I will nurse my baby for 5 to 10 minutes on each breast.
- B. I will make sure that just the nipple is in my baby's mouth.
- C. I will apply vitamin E oil to my nipples after each feeding.
- D. I will lay my baby on a pillow at the level of my breast.
Correct Answer: D
Rationale: Using a pillow to support the baby at breast level ensures proper positioning and latch, making breastfeeding more comfortable and effective, indicating understanding of the teaching.