Nokea
Which of the following tests is commonly performed on newborns with jaundice?
- A. blood urea nitrogen
- B. magnesium
- C. bilirubin
- D. prolactin
Correct Answer: C
Rationale: Bilirubin levels are tested in newborns with jaundice to assess liver function and the severity of hyperbilirubinemia.
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A client with a diagnosis of Schizophrenia has been released from an acute care setting. The client had a prolonged recovery from relapse. One of the parents says to the discharge nurse, 'I do not understand what is going on. The hospital said she was better, but all she does is sit around all day and smoke. We cannot get her to go to the vocational training you arranged.' The nurse recognizes that more teaching is needed about
- A. the pathophysiology and behavioral manifestations of schizophrenia.
- B. support groups that can help the parents cope with their frustration.
- C. the prolonged recovery time and side effects of medications to prevent relapse.
- D. motivational techniques that are effective in engaging clients with schizophrenia.
Correct Answer: C
Rationale: The nurse conducting discharge teaching must emphasize the extended recovery process and the potential side effects of medications used to prevent relapse in individuals with schizophrenia. In this scenario, it is crucial for the parents to understand that the client's behavior may be influenced by the medication's sedative qualities and the time required for full recovery. While support groups can assist caregivers in coping with their emotions and providing better care, the priority here is educating on the recovery process and medication effects. Motivational techniques are beneficial but may not be the immediate focus in this situation.
The nurse is teaching a client about the use of Rifampin for prophylaxis after an exposure to meningitis. What change in bodily functions should the nurse advise the client about?
- A. The client's urine might turn blue
- B. The client remains infectious to others for 48 hours
- C. The client's contact lenses might be stained orange
- D. The client's skin might take on a crimson glow
Correct Answer: C
Rationale: Rifampin causes orange discoloration of body fluids, which can permanently stain soft contact lenses, requiring client education to prevent concern or damage.
A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with:
- A. wearing clothing that is too small for the child.
- B. the child being shaken.
- C. falling while learning to walk.
- D. parents trying to awaken the child.
Correct Answer: B
Rationale: The correct answer is 'the child being shaken.' In cases of suspected child abuse, bruises on both upper arms can be indicative of a child being shaken, as children who are shaken are frequently grasped by both upper arms. The presentation of a 10-month-old child being difficult to awaken, along with bruises on the upper arms, raises concern for inflicted injury. Symptoms of brain injury associated with shaking include a decreased level of consciousness. Choices A, C, and D are less likely in this scenario as they do not align with the concerning signs of suspected abuse indicated by the bruises and the child's altered level of consciousness.
A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:
- A. naloxone (Narcan).
- B. labetalol (Normodyne).
- C. neostigmine (Prostigmin).
- D. thiothixene (Navane).
Correct Answer: A
Rationale: When a client becomes extremely somnolent with respiratory depression after being given an opiate drug, the physician is likely to order the administration of naloxone (Narcan). Naloxone is an opiate antagonist that attaches to opiate receptors, blocking or reversing the action of narcotic analgesics. Choices B, C, and D are incorrect. Labetalol is a beta blocker used for hypertension, neostigmine is an anticholinesterase agent used to treat myasthenia gravis and reverse neuromuscular blockade, and thiothixene is an antipsychotic agent used for psychiatric conditions.
A mother has just given birth to a baby who died soon after. The mother has been crying and states, 'I can't believe this has happened to me. I did everything right during this pregnancy.' How should the nurse respond to this mother?
- A. Tell her she did nothing wrong; it was God's will.
- B. Tell her she can have another baby.
- C. Tell her that her behavior is not going to solve anything.
- D. Tell her nothing and let her mourn this loss in the manner she chooses.
Correct Answer: D
Rationale: Perinatal loss is a great tragedy for the parents. A bereaved mother must resolve the crisis of perinatal loss in addition to the crisis of pregnancy. Such a loss is described as losing part of one's self-loss of self-worth. The perinatal grief response must involve attachment and detachment as a part of the mourning process.