A nurse assesses that a 3-day-old neonate who was born at 34 weeks' gestation has abdominal distention and vomiting. These assessment findings are most likely related to:
a. Respiratory Distress Syndrome (RDS)b. Bronchopulmonary Dysplasia (BPD)c. Periventricular Hemorrhage (PVH)d. Necrotizing Enterocolitis (NEC)
ANS: d
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a. Assessment findings for RDS include tachypnea, intercostal retractions, respiratory grunting, and nasal flaring.
b. Assessment findings for BPD include chest retractions; audible wheezing, rales, and rhonchi; hypoxia; and bronchospasm.
c. Assessment findings for PVH include bradycardia, hypotonia, full and/or tense anterior fontanel, and hyperglycemia.
d. Assessment findings related to NEC include abdominal distention, bloody stools, abdominal distention, vomiting, and increased gastric residual. These signs and symptoms are related to the premature neonate's inability to fully digest stomach contents and limitation in absorptive function.
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The nurse is planning a teaching session with the client who is about to be discharged. Which of the following, if planned by the nurse, would enhance the client learning experience? Select all that apply. Standard Text: Select all that apply
1. The nurse plans to ask the client to select the time of the session. 2. The nurse plans to show the client a videotape while the client rests in bed. 3. The nurse plans to advise the client to use the supplies from the hospital. 4. The nurse plans to review the material at the end of the session. 5. The nurse plans on using appropriate medical terminology.
During an interview with several clients, the community health nurse works with the group to determine what the clients mean. The nurse is demonstrating which of the following?
A) Reflection B) Respect C) Empathy D) Active listening
After delivery of the infant, the nurse adds 20 units of oxytocin to the intravenous solution. The nurse understands that the purpose of this medication is to
a. suppress lactation in a nonbreastfeeding mother b. shorten the length of the third stage of labor c. promote comfort during the immediate postpartum period d. prevent postpartum hemorrhage
A pregnant woman tells a nurse that she takes daily vitamin supplements. Since learning about her pregnancy, she has increased her vitamin A supplement to 1200 RAEs per day. The nurse should:
1. confirm that this dose is appropriate during pregnancy. 2. encourage the patient to increase the dose to 1500 RAEs to promote the development of the central nervous system of the fetus. 3. recommend that the patient decrease the dose to less than 700 RAEs because higher doses may be teratogenic. 4. inform the patient that because vitamin A is water soluble, large doses are needed to maintain skin integrity.