The nurse completes the initial assessment of a newborn. Which finding would lead the nurse to suspect that the newborn is experiencing difficulty with oxygenation?
A) Respiratory rate of 54 breaths/minute
B) Abdominal breathing
C) Nasal flaring
D) Acrocyanosis
C
Feedback:
Nasal flaring is a sign of respiratory difficulty in the newborn. A rate of 54 breaths/minute, diaphragmatic/abdominal breathing, and acrocyanosis are normal findings.
You might also like to view...
An older adult client who has a history of falls has been placed in physical restraints after the failure of all other alternatives for fall prevention. What actions should the nurse take to en-sure the safety of the client in restraints?
A. Check the client every hour, while keeping the restraints in place. B. Check the client every 30 to 60 minutes, releasing the restraints every 2 hours. C. Check the client once each shift, releasing the restraints for feeding only. D. Check the client twice each shift, keeping the restraints in place.
A patient's skin lesion has been described as a nodule. The nurse expects which findings to be present? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. The margins of the lesion are clearly identifiable. 2. The lesion is pus-filled. 3. The lesion is flat and nonpalpable. 4. The lesion is firm. 5. The lesion is within the dermis.
The client complains to the nurse about the noise at the nurse's station at night. The nurse's best response is:
a. "I appreciate your reporting this to me." b. "Thank you for contributing this information." c. "What do you want me to do about this?" d. "Are you saying that you are unable to rest at night because of the noise?"
Which is a community nursing diagnosis?
A) Impaired Home Maintenance B) Lack of Health-Seeking Behaviors C) Risk for Imbalanced Nutrition: More than Body Requirements D) Risk for Activity Intolerance