The parents of a preterm newborn wish to visit their baby in the NICU. A statement by the nurse that would not support the parents as they visit their newborn is which of the following?
1. "Your newborn likes to be touched."
2. "Stroking the newborn will help with stimulation."
3. "Visits must be scheduled between feedings."
4. "Your baby loves her pink blanket."
3
Explanation: 3. The nurse always should encourage parents to visit and get to know their newborn, even in the NICU. Nurses foster the development of a safe, trusting environment by viewing the parents as essential caregivers, not as visitors or nuisances in the unit.
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A critically ill child who is experiencing internal bleeding from a motor vehicle accident demonstrates a sudden significant drop in blood pressure. What intervention should the nurse implement first?
A) Administer 20 mL/kg intravenous crystalloid fluid. B) Assess for oversedation with benzodiazepines or narcotics. C) Increase frequency of vital sign assessment to every 15 minutes. D) Reassess mental status and level of consciousness.
A woman is having an infertility workup and has been told she has scarring of her fallopian tubes. What action by the nurse is best?
A. Ask the woman how many sexually transmitted infections she has had. B. Assess the woman for previous vaginal infections and their treatment. C. Gently tell the woman that nothing can be done about scarring of the tubes. D. Question the woman about genetic defects or family history of infertility.
The nurse notes that the patient has developed a hematoma at the knee replacement surgical site with a decreased pedal pulse of the same leg. The most appropriate nursing diagnosis for this patient is:
A) Risk for infection B) Risk of peripheral neurovascular dysfunction C) Ineffective health maintenance D) Self-esteem disturbance
What is the primary reason a nurse should develop learning objectives for all client teaching?
a. The nurse clarifies what actions or beha-viors are expected. b. It is a requirement by the Joint Commis-sion on Accreditation of Healthcare Or-ganizations. c. Learning objectives help the nurse to or-ganize the teaching materials. d. Clients who do not have objectives will learn material poorly.