A neonate is born to a diabetic mother. The baby is very large, weighing 10 lb. The nurse plans care of the neonate accordingly. Nursing care will include:
a. Holding feedings to help reduce blood glucose
b. Monitoring blood glucose levels carefully
c. Checking vital signs each shift
d. None of the above
B
Feedings are initiated early after birth. Blood glucose levels are monitored closely. The vital signs and condition of the infant are monitored closely, more than once per shift.
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A patient says, "I hate this yucky paste under my appliance. I think I will just tape it on." What is the best response by the nurse?
a. "Taping will not work!" b. "Taping will not seal the wafer tight enough to prevent leakage or fill increas-es." c. "Taping with waterproof tape is just as effective as the paste." d. "Taping is far more irritating to the skin than the paste would be."
Which of the following would be considered a mechanical defense mechanism?
A) Cast B) Coughing C) Clothing D) Sunscreen
What is the major nursing concern for a child having an anaphylactic reaction?
a. Identifying the offending allergen b. Ineffective breathing pattern c. Increased cardiac output d. Positioning to facilitate comfort
A patient with septic shock has a BP of 70/46 mm Hg, pulse 136, respirations 32, temperature 104° F, and blood glucose 246 mg/dL. Which intervention ordered by the health care provider should the nurse implement first?
a. Give normal saline IV at 500 mL/hr. b. Give acetaminophen (Tylenol) 650 mg rectally. c. Start insulin drip to maintain blood glucose at 110 to 150 mg/dL. d. Start norepinephrine (Levophed) to keep systolic blood pressure >90 mm Hg.