Nurse is planning care for a requires phototherapy for hyperbilirubinemia. Which of the
following movements ought to the nurse include inthe plan of care - ANSEnsure the
newborns eyes are closed before applying the eye guard - Overexposure to the lighting
fixtures all through remedy can purpose harm to the new child's corneas. Therefore, the
nurse should lightly near the newborn's eyes prior to making use of the eye defend.
A nurse is being concerned for a customer at 34 weeks gestation and has a prescription for
terbutaline for preterm labor. Which of the subsequent statements by using the patient is the
priority? - ANS"My coronary heart feels as though it's miles racing." - the nurse need to
determine the purchaser's heart charge. The number one motion of terbutaline is to reason
bronchodilation and relax easy muscles. However, an adverse effect is tachycardia. If the
heart beat is extra than a hundred thirty/min, the terbutaline desires to be held till the
provider is notified. The nurse may additionally need to apply Maslow's hierarchy of needs,
the ABC precedence-placing framework, or nursing know-how to discover which finding is
the maximum urgent.
A nurse is planning care for a client who is pregnant and is Rh-negative. In which of the
following situations should the nurse administer Rh(D) Immune Globulin? - ANSAt 28 weeks
of gestation - The nurse need to administer Rh(D) Immune Globulin to a purchaser who's
pregnant and has Rh-bad blood at 28 weeks of gestation. Rh(D) Immune Globulin includes
passive antibodies in opposition to the Rh element, so that it will spoil any fetal RBCs inside
the maternal circulate and block maternal antibody manufacturing.
A nurse is caring for a customer who is at 39 weeks of gestation and is in energetic hard
work. Which of the following movements must the nurse consist of inside the plan of care? -
ANSCheck the cervix prior to analgesic management. - Prior to administering an analgesic
at some point of lively labor, the nurse must recognise what number of centimeters the cervix
is dilated. If administered too close to the time of delivery, the analgesic may want to cause
breathing melancholy in the new child.
A nurse is making plans take care of a consumer who's at 35 weeks of gestation. Which of
the following lab exams must the nurse obtain? - ANSGroup B streptococcus Beta-hemolytic
(GBS) - The nurse ought to reap a vaginal/anal group B streptococcus ß-hemolytic (GBS)
tradition at 35 to 37 weeks of gestation to display screen for infection. Prophylactic
antibiotics have to take delivery of during labor to the customer who is nice for GBS.
A nurse is caring for a new child whose mother received magnesium sulfate to treat preterm
labor. Which of the following clinical manifestations is the newborn suggests toxicity due to
the magnesium sulfate remedy? - ANSRespiratory melancholy - Magnesium sulfate can
reason respiration and neuromuscular depression inside the newborn. The nurse have to
screen the newborn for scientific manifestations of respiratory melancholy.
, A nurse is being concerned for a purchaser who is in labor and has an epidural for ache
alleviation. Which of the subsequent is a problem from the epidural block? - ANShypotension
- Maternal hypotension is an destructive impact of epidural anesthesia. The nurse must
administer an IV fluid bolus previous to the placement of epidural anesthesia which will lower
the probability of this difficulty.
A nurse is being concerned for a consumer who has trichomoniasis and a prescription for
metronidazole. Which of the subsequent instructions have to the nurse offer to the client
approximately the remedy plan? - ANS"You and your accomplice need to take the medicine
and use a condom all through sex until cultures are poor." - Trichomonas vaginalis is the
organism that reasons the sexually transmitted infection trichomoniasis. Both women and
men can be infected with trichomoniasis. Clinical findings consist of yellowish to greenish,
frothy, mucopurulent, copious discharge with an unsightly scent, in addition to itching,
burning, or redness of the vulva and vagina. Trichomoniasis can be handled without difficulty
with metronidazole. However, for the remedy to paintings, it's far crucial to make sure both
sexual companions get hold of remedy to save you reinfection. Instruct the customer to use
condoms at some stage in sexual sex whilst being treated.
A nurse in a prenatal health center is worrying for a purchaser who's inside the
recommended tenet for weight. The client asks the nurse how a whole lot weight is secure
for her to benefit at some point of her pregnancy. Which of the following responses need to
the nurse make? - ANSA weight gain of 25 - 35 lbs is right - A weight gain of 25 to 35 lb is
associated with suitable fetal outcome. A advantage of four lb inside the first trimester and
12 lb every for the second one and 1/3 trimester is usually recommended.
A nurse is caring for a consumer who has a prescription for naloxone. Which of the
subsequent is the intended motion of the med when it comes to the CNS? - ANSBlock
outcomes of narcotics at the CNS- By blockading the outcomes of narcotics at the CNS,
naloxone prevents CNS and respiratory despair in the new child following shipping.
A nurse is discussing diaphragm use with a client. Which of the following statements through
purchaser indicates an know-how of the teaching? - ANSI have to replace my diaphragm
each 2 years - The diaphragm is a flexible rubber cup that is packed with spermicide and is
inserted over the cervix prior to intercourse. The diaphragm is a prescribed tool geared up by
means of the provider. It should get replaced every 2 years.
A nurse is teaching a customer about a nonstress check. Which of the subsequent
statements by means of the customer indicates an information of the coaching? - ANSI must
press the button on the hand held marker while my child actions - The motive of the take a
look at is to evaluate fetal nicely-being. The consumer must press the button on the hand
held marker while she feels fetal motion.
A nurse is being concerned for a customer who's 2 hr postpartum. The nurse notes the
purchaser's perineal pad has a large amount of lochia rubra with several clots. Which of the
subsequent movements should the nurse take first? - ANSMassage the fundus - The
number one cause of early postpartum bleeding is uterine atony manifested by using a
relaxed, boggy uterus. Thus, the finest danger for the purchaser is hemorrhage. The nurse
ought to rubdown the consumer's fundus first.
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