A client is concerned because she has been told her blood type and her baby's are incompatible. What is the nurse's best response?
1. "This is called ABO incompatibility. It is somewhat common but rarely causes significant hemolysis."
2. "This is a serious condition, and additional blood studies are currently in process to determine whether you need a medication to prevent it from occurring with a future pregnancy."
3. "This is a condition caused by a blood incompatibility between you and your husband, but does not affect the baby."
4. "This type of condition is very common, and the baby can receive a medication to prevent jaundice from occurring."
1
Explanation: 1. When blood types, not Rh, are incompatible, it is called ABO incompatibility. The incompatibility occurs as a result of the maternal antibodies present in her serum and interaction between the antigen sites on the fetal RBCs.
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A nursing instructor is educating a class of student nurses about charting direct statements made by a patient. The best example of this would be
1. States, "He vomited everything he ate and drank yesterday." 2. States, "He is in excruciating pain. The pain is unrelieved by analgesics." 3. States, "The pain is getting worse. I don't know if I can stand it or not." 4. States, "His pain is getting worse and he doesn't know if he can stand it or not."
Which of the following fetal surveillance procedures is used for screening?
a. Fetal tissue sampling c. Human placental lactogen b. Fetal cell isolation d. Fetal movement counting
Within a 15-minute period, a patient having a manic episode voices these complaints
"Dinner was cold. The bath towels are rough. The solarium is too hot. I have a sore throat. Another patient needs a shower. The medication nurse is too slow." The nurse should: a. listen but ignore the patient's complaints. b. tell the patient to use the suggestion box. c. assess the patient's throat, and take vital signs. d. invite the patient to share the concerns at the community meeting.
The nurse is about to take vital signs on a newborn patient in the nursery. She should:
a. assess respiratory rate after taking a rectal temperature. b. observe the child's chest while the child is sleeping. c. call the physician if the rate is over 40. d. expect that the child will have short periods of apnea.