Nokea
Which statement would be a correct description of colostrum?
- A. Slightly yellow and low in protein
- B. Slightly yellow and provides antibodies
- C. Creamy and high in fat and protein
- D. Colorless and high in fat and carbohydrates
Correct Answer: B
Rationale: Colostrum is slightly yellow in color and is rich in antibodies.
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A new Native American mother tells the nurse that when she goes home her mother-in-law will be caring for the baby while she rests. The nurse has concerns. What should the nurse do?
- A. Explain the importance of ambulating to recover.
- B. Explain the importance of maternal-infant bonding.
- C. Explore ways to blend this with safe health teaching.
- D. Encourage this cultural behavior.
Correct Answer: C
Rationale: Follow principles that facilitate nursing practice within transcultural situations.
The nurse is caring for a newborn who was circumcised earlier in the day. What should be included in the plan of care?
- A. Administration of a topical anesthetic to the site
- B. Application of ice to stop bleeding
- C. Retraction of any remaining foreskin
- D. Observation for bleeding for the first 12 hours
Correct Answer: D
Rationale: The nurse should assess for bleeding for the first 12 hours following the circumcision. Gentle pressure should be applied to control bleeding. The administration of topical anesthetic and the retraction of the remaining foreskin are not included in the plan of care.
What should be included when discussing the care of a circumcised infant after discharge from the hospital?
- A. Gently remove the yellow exudate from the foreskin.
- B. Apply sterile petroleum gauze after each diaper change.
- C. Wipe the circumcision with alcohol each day.
- D. Avoid the use of cloth diapers until the foreskin has healed.
Correct Answer: B
Rationale: Wash the penis at diaper change and apply sterile petroleum gauze. The yellow exudate should not be removed as it is part of the normal healing process. The circumcised area should be cleansed gently, not with alcohol. Cloth diapers are sometimes recommended to promote healing.
Why is vitamin K given by injection to the newborn?
- A. Most mothers have a vitamin K deficiency that develops during pregnancy.
- B. Bacteria that synthesize vitamin K are not present in newborns.
- C. Vitamin K prevents the synthesis of prothrombin.
- D. The newborn does not store vitamin K.
Correct Answer: B
Rationale: Newborns are not able to synthesize vitamin K in the colon until they have adequate intestinal flora, therefore, the vitamin K injection is given as a prevention measure against hemorrhage.
Which finding should the nurse suspect as abnormal in the newborn during the initial assessment?
- A. Eyes crossed at times
- B. Persistent high-pitched cry
- C. Arms and legs flexed
- D. Slight bluish tinge of the extremities
Correct Answer: B
Rationale: A high-pitched cry may indicate neurologic problems. Occasional crossing of the eyes, flexing of the arms and legs, and a bluish tinge of the extremities are all considered normal assessment findings in the newborn.