The client at 39 weeks' gestation is undergoing a cesarean birth due to breech presentation. General anesthesia is being used. Which situation requires immediate intervention?
1. The baby's hands and feet are blue at 1 minute of age.
2. Fetal heart rate is 70 prior to making the skin incision.
3. Clear fluid is obtained from the baby's oropharynx.
4. The neonate cries prior to delivery of the body.
2
Rationale:
1. Acrocyanosis is an expected finding at 1 minute of age.
2. Fetal bradycardia is often caused by supine hypotension syndrome. The client should be tilted to the left side to restore adequate vena cava circulation and oxygenation of the fetus.
3. This is an expected finding.
4. General anesthesia can cause neonatal respiratory depression. Crying after delivery of just the head indicates that no neonatal depression has occurred.
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A nurse manager wants to make the pediatric clinic a more family-centered health-care setting. Which of the following actions by the nursing staff would best meet this goal?
A. Encourage family members to be present in the exam room and to ask questions. B. Incorporate the use of a community health map for all new patients in the clinic. C. Recognize family members as experts on their child and incorporate them in decision making. D. Use evidence-based practice to develop policies and procedures used in the clinic.
What visible skin change of the breast does she have?
A 56-year-old female comes to your clinic, complaining of her left breast looking unusual. She says that for 2 months the angle of the nipple has changed direction. She does not do self-examinations, so she doesn't know if she has a lump. She has no history of weight loss, weight gain, fever, or night sweats. Her past medical history is significant for high blood pressure. She smokes two packs of cigarettes a day and has three to four drinks per weekend night. Her paternal aunt died of breast cancer in her forties. Her mother is healthy but her father died of prostate cancer. On examination you find a middle-aged woman appearing older than her stated age. Inspection of her left breast reveals a flattened nipple deviating toward the lateral side. On palpation the nipple feels thickened. Lateral to the areola you palpate a nontender 4-cm mass. The axilla contains several fixed nodes. The right breast and axilla examinations are unremarkable. A) Nipple retraction B) Paget's disease C) Peau d'orange sign
When a patient requires an ever-increasing dose of a medication to achieve the same therapeutic effect, the nurse must assess the patient for:
a. withdrawal. b. patency. c. side effects. d. tolerance.
A newly licensed nurse tells a nurse manager, "I'd like you to stop referring to me as ‘the smart new degree nurse.'" The nurse manager replies, "I was only teasing. You are being overly sensitive."
Which statement accurately evaluates the newly licensed nurse's comment to the nurse manager? a. The nurse is appropriately assertive, but now the nurse manager will likely belittle the nurse even more. b. The nurse is behaving aggressively because of the newness of being a graduate licensed nurse and owes the nurse manager an apology. c. The nurse is assertive, and responding that the nurse does not regard the nurse manager's comments as "teasing" would be an effective follow-up communication. d. The nurse is overly sensitive and ought to have ignored the nurse manager's teasing until it was extinguished. Now the nurse manager will be more sarcastic than ever.