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1. A nurse is providing discharge instructions about newborn care to a pt who is 2 days
postpartum. Which of the following statements indicates to the nurse that the pt
understands the teaching
A. "I will breastfeed my baby on a schedule of every 4 hours."
B. "I will bathe my baby daily."
C. "I will be place my baby on her stomach for sleeping."
D. "I will cover my baby's body when I wash her hair."
E. "I will use the bulb syringe first in her mouth and then in her nose."
...Ans>> D. "I will cover my baby's body when I wash her hair."
A. "I will use the bulb syringe first in her mouth and then in her nose."
Newborns are highly susceptible to heat loss. The client should wrap the newborn in a
towel when washing the hair to minimize heat loss.
,Daily bathing can disrupt the integrity of the newborn's skin, but the client should clean th
perineum after every diaper change.
2. A nurse is caring for a client who has cancer and is deciding between two treatment
plans. The pt asks the nurse for assistance in making a decision. Which of the following
responses should the nurse make?
A. "It's been difficult for everyone who has ever had to make this decision."
B. "Tell me more about your understanding of the options."
C. "I'm sure you will make the right choice."
D. "I will contact your provider to have him talk with you further."
...Ans>> B. "Tell me more about your understanding of the options."
3. A nurse is preparing for a pt for a paracentesis. Which of the following actions
should the nurse take?
A. Instruct the client to void.
B. Position the client on his left side.
C. Insert an IV catheter.
D. Prepare the client for conscious sedation.
...Ans>> A. Instruct the client to void.
,4. A nurse is caring for a pt who is receiving positive end expiratory pressure (PEEP) via
mechanical ventilator. The nurse should monitor the pt for which of the following
adverse effects of PEEP?
A. Hypoxemia
B. Tension pneumothorax
C. Malignant hypertension
D. Atelectasis
...Ans>> B. Tension pneumothorax
5. A nurse is assessing an infant who has hydrocephalus and is 6 hr postop following
placement of a VP shunt. Which of the following findings should the nurse report to the
provider?
A. Heart rate 122/min
B. Irritability when being held
C. Hypoactive bowel sounds
D. Urine specific gravity 1.018
...Ans>> B. Irritability when being held
6. A nurse is performing an admission assessment on a pt who had a recent positive
prego test. The first day of her last menstrual period was May 8. According to Nagele's
rule, which of the following dates should the nurse document as the pt's estimated
date of birth?
, A. February 1
B. February 8
C. February 15
D. February 22
...Ans>> C. February 15
Using Nägele's rule, the nurse should add 7 days to the first day of the client's LMP (8 + 7 =
15) and then subtract 3 months. Therefore, the nurse should document the client's EDB as
February 15th.
7. A nurse at a mental health clinic is caring for four pts. The nurse should recognize
that which of the following pts is using dissociation of a defense mechanism?
A. A client forgets to buy her partner a birthday gift after a disagreement.
B. A client who was abused as a child describes the abuse as if it happened to someone
else.
C. A client who is shorter than average is verbally assertive with his co-work- ers.
D. A client states that she did not get a job promotion because the boss does