Test Bank Maternal Child Nursing Care 5th Edition Perry

Test Bank Maternal Child Nursing Care 5th Edition Perry-Free PDF

  • Date:11 Oct 2020
  • Views:5
  • Downloads:0
  • Pages:10
  • Size:259.17 KB

Share Pdf : Test Bank Maternal Child Nursing Care 5th Edition Perry

Download and Preview : Test Bank Maternal Child Nursing Care 5th Edition Perry


Report CopyRight/DMCA Form For : Test Bank Maternal Child Nursing Care 5th Edition Perry


Transcription:

c Smooth pink skin with visible veins,d Faint red marks on the soles of the feet. Term infants typically have a flexed posture Abundant lanugo usually is seen on preterm. infants Smooth pink skin with visible veins is seen on preterm infants Faint red marks. usually are seen on preterm infants,PTS 1 DIF Cognitive Level Comprehension REF 587. OBJ Nursing Process Diagnosis MSC Client Needs Health Promotion and Maintenance. 4 A 3 8 kg infant was delivered vaginally at 39 weeks after a 30 minute second stage There. was a nuchal cord After birth the infant is noted to have petechiae over the face and upper. back Information given to the infant s parents should be based on the knowledge that. a Are benign if they disappear within 48 hours of birth. b Result from increased blood volume,c Should always be further investigated. d Usually occur with forceps delivery, Petechiae or pinpoint hemorrhagic areas acquired during birth may extend over the upper. portion of the trunk and face These lesions are benign if they disappear within 2 days of birth. and no new lesions appear Petechiae may result from decreased platelet formation In this. situation the presence of petechiae is most likely a soft tissue injury resulting from the nuchal. cord at birth Unless they do not dissipate in 2 days there is no reason to alarm the family. Petechiae usually occur with a breech presentation vaginal birth. PTS 1 DIF Cognitive Level Application REF 605, OBJ Nursing Process Assessment MSC Client Needs Health Promotion and Maintenance.
5 A newborn is jaundiced and receiving phototherapy via ultraviolet bank lights An appropriate. nursing intervention when caring for an infant with hyperbilirubinemia and receiving. phototherapy by this method would be to, a Apply an oil based lotion to the newborn s skin to prevent dying and cracking. b Limit the newborn s intake of milk to prevent nausea vomiting and diarrhea. c Place eye shields over the newborn s closed eyes. d Change the newborn s position every 4 hours, The infant s eyes must be protected by an opaque mask to prevent overexposure to the light. Eye shields should cover the eyes completely but not occlude the nares Lotions and ointments. should not be applied to the infant because they absorb heat and this can cause burns The. lights increase insensible water loss placing the infant at risk for fluid loss and dehydration. Therefore it is important that the infant be adequately hydrated The infant should be turned. every 2 hours to expose all body surfaces to the light. PTS 1 DIF Cognitive Level Application REF 605,OBJ Nursing Process Planning. MSC Client Needs Safe and Effective Care Environment. 6 Early this morning an infant boy was circumcised using the PlastiBell method The nurse tells. the mother that she and the infant can be discharged after. a The bleeding stops completely,b Yellow exudate forms over the glans. c The PlastiBell rim falls off,d The infant voids, The infant should be observed for urination after the circumcision Bleeding is a common.
complication after circumcision The nurse will check the penis for 12 hours after a. circumcision to assess and provide appropriate interventions for prevention and treatment of. bleeding Yellow exudates cover the glans penis in 24 hours after the circumcision This is. part of normal healing and not an infective process The PlastiBell remains in place for about. a week and falls off when healing has taken place,PTS 1 DIF Cognitive Level Comprehension REF 615. OBJ Nursing Process Planning MSC Client Needs Health Promotion and Maintenance. 7 A mother expresses fear about changing her infant s diaper after he is circumcised What does. the woman need to be taught to take care of the infant when she gets home. a Cleanse the penis with prepackaged diaper wipes every 3 to 4 hours. b Apply constant firm pressure by squeezing the penis with the fingers for at least 5. minutes if bleeding occurs, c Cleanse the penis gently with water and put petroleum jelly around the glans after. each diaper change, d Wash off the yellow exudate that forms on the glans at least once every day to. prevent infection, Cleansing the penis gently with water and putting petroleum jelly around the glans after each. diaper change are appropriate when caring for an infant who has had a circumcision With. each diaper change the penis should be washed off with warm water to remove any urine or. feces If bleeding occurs the nurse should apply gentle pressure to the site of the bleeding. with a sterile gauze square Yellow exudates cover the glans penis in 24 hours after the. circumcision This is part of normal healing and not an infective process The exudates should. not be removed,PTS 1 DIF Cognitive Level Application REF 617.
OBJ Nursing Process Planning MSC Client Needs Health Promotion and Maintenance. 8 When preparing to administer a hepatitis B vaccine to a newborn the nurse should. a Obtain a syringe with a 25 gauge 5 8 inch needle. b Confirm that the newborn s mother has been infected with the hepatitis B virus. c Assess the dorsogluteal muscle as the preferred site for injection. d Confirm that the newborn is at least 24 hours old. The hepatitis B vaccine should be administered with a 25 gauge 5 8 inch needle Hepatitis B. vaccination is recommended for all infants If the infant is born to an infected mother who is a. chronic carrier hepatitis vaccine and hepatitis B immune globulin should be administered. within 12 hours of birth Hepatitis B vaccine should be given in the vastus lateralis muscle. Hepatitis B vaccine can be given at birth,PTS 1 DIF Cognitive Level Application REF 613. OBJ Nursing Process Implementation MSC Client Needs Health Promotion and Maintenance. 9 The nurse is performing a gestational age and physical assessment on the newborn The infant. appears to have an excessive amount of saliva The nurse recognizes that this finding. a Is normal,b Indicates that the infant is hungry, c May indicate that the infant has a tracheoesophageal fistula or esophageal atresia. d May indicate that the infant has a diaphragmatic hernia. The presence of excessive saliva in a neonate should alert the nurse to the possibility of. tracheoesophageal fistula or esophageal atresia,PTS 1 DIF Cognitive Level Analysis REF 595. OBJ Nursing Process Assessment MSC Client Needs Physiologic Integrity. 10 As part of Standard Precautions nurses wear gloves when handling the newborn The chief. a To protect the baby from infection,b That it is part of the Apgar protocol. c To protect the nurse from contamination by the newborn. d the nurse has primary responsibility for the baby during the first 2 hours. Gloves are worn to protect the nurse from infection until the blood and amniotic fluid are. cleaned off the newborn,PTS 1 DIF Cognitive Level Comprehension REF 613.
OBJ Nursing Process Implementation, MSC Client Needs Safe and Effective Care Environment. 11 The nurse s initial action when caring for an infant with a slightly decreased temperature is to. a Notify the physician immediately, b Place a cap on the infant s head and have the mother perform kangaroo care. c Tell the mother that the infant must be kept in the nursery and observed for the. next 4 hours, d Change the formula because this is a sign of formula intolerance. Keeping the head well covered with a cap will prevent further heat loss from the head and. having the mother place the infant skin to skin should increase the infant s temperature. Nursing actions are needed first to correct the problem If the problem persists after. interventions notification may then be necessary A slightly decreased temperature can be. treated in the mother s room This would be an excellent time for parent teaching on. prevention of cold stress Mild temperature instability is an expected deviation from normal. during the first days as the infant adapts to external life. PTS 1 DIF Cognitive Level Application REF 620, OBJ Nursing Process Implementation MSC Client Needs Health Promotion and Maintenance. 12 An Apgar score of 10 at 1 minute after birth would indicate a n. a Infant having no difficulty adjusting to extrauterine life and needing no further. b Infant in severe distress who needs resuscitation. c Prediction of a future free of neurologic problems. d Infant having no difficulty adjusting to extrauterine life but who should be. assessed again at 5 minutes after birth, An initial Apgar score of 10 is a good sign of healthy adaptation however it must be repeated.
at the 5 minute mark,PTS 1 DIF Cognitive Level Comprehension REF 583. OBJ Nursing Process Planning MSC Client Needs Physiologic Integrity. 13 With regard to umbilical cord care nurses should be aware that. a The stump can easily become infected, b A nurse noting bleeding from the vessels of the cord should immediately call for. assistance,c The cord clamp is removed at cord separation. d The average cord separation time is 5 to 7 days, The cord stump is an excellent medium for bacterial growth The nurse should first check the. clamp or tie and apply a second one If the bleeding does not stop the nurse calls for. assistance The cord clamp is removed after 24 hours when it is dry The average cord. separation time is 10 to 14 days,PTS 1 DIF Cognitive Level Comprehension REF 627.
OBJ Nursing Process Planning, MSC Client Needs Safe and Effective Care Environment. 14 In the classification of newborns by gestational age and birth weight the appropriate for. gestational age AGA weight would, a Fall between the 25th and 75th percentiles for the infant s age. b Depend on the infant s length and the size of the head. c Fall between the 10th and 90th percentiles for the infant s age. d Be modified to consider intrauterine growth restriction IUGR. The AGA range is large between the 10th and the 90th percentiles for the infant s age The. infant s length and size of the head are measured but they do not affect the normal weight. designation IUGR applies to the fetus not the newborn s weight. PTS 1 DIF Cognitive Level Comprehension REF 601, OBJ Nursing Process Diagnosis MSC Client Needs Health Promotion and Maintenance. 15 During the complete physical examination 24 hours after birth. a The parents are excused to reduce their normal anxiety. b The nurse can gauge the neonate s maturity level by assessing the infant s general. appearance, c Once often neglected blood pressure is now routinely checked. d When the nurse listens to the heart the S1 and S2 sounds can be heard the first. sound is somewhat higher in pitch and sharper than the second. The nurse will be looking at skin color alertness cry head size and other features The. parents presence actively involves them in child care and gives the nurse a chance to observe. interactions Blood pressure is not usually taken unless cardiac problems are suspected The. second sound is higher and sharper than the first,PTS 1 DIF Cognitive Level Comprehension REF 583.
OBJ Nursing Process Assessment MSC Client Needs Health Promotion and Maintenance. 16 As related to laboratory tests and diagnostic tests in the hospital after birth nurses should be. aware that, a All states test for phenylketonuria PKU hypothyroidism cystic fibrosis and. sickle cell diseases, b Federal law prohibits newborn genetic testing without parental consent. c If genetic screening is done before the infant is 24 hours old it should be repeated. at age 1 to 2 weeks, d Hearing screening is now mandated by federal law. If done very early genetic screening should be repeated States all test for PKU and. hypothyroidism but other genetic defects are not universally covered Federal law mandates. newborn genetic screening but not screening for hearing problems although more than half. the states do mandate hearing screening,PTS 1 DIF Cognitive Level Knowledge REF 609. OBJ Nursing Process Planning MSC Client Needs Physiologic Integrity. 17 Nurses can assist parents who are trying to decide whether their son should be circumcised by. explaining, a The pros and cons of the procedure during the prenatal period.
b That the American Academy of Pediatrics AAP recommends that all newborn. boys be routinely circumcised, c That circumcision is rarely painful and any discomfort can be managed without. medication, d That the infant will likely be alert and hungry shortly after the procedure. Many parents find themselves making the decision during the pressure of labor The AAP and. other professional organizations note the benefits but stop short of recommendation for. routine circumcision Circumcision is painful and must be managed with environmental. nonpharmacologic and pharmacologic measures After the procedure the infant may be fussy. for several hours or he may be sleepy and difficult to awaken for feeding. PTS 1 DIF Cognitive Level Comprehension REF 615, OBJ Nursing Process Planning MSC Client Needs Health Promotion and Maintenance. 18 As part of their teaching function at discharge nurses should educate parents regarding safe. sleep Which statement is incorrect, a Prevent exposure to people with upper respiratory tract infections. b Keep the infant away from secondhand smoke, c Avoid loose bedding water beds and beanbag chairs.
d Place the infant on his or her abdomen to sleep, The infant should be laid down to sleep on his or her back for better breathing and to prevent. sudden infant death syndrome Infants are vulnerable to respiratory infections infected people. Instant download and all chapters Test Bank Maternal Child Nursing Care 5th Edition Perry bank maternal child nursing care 5th edition perry c Smooth pink skin with visible veins d Faint red marks on the soles of the feet ANS A Term infants typically have a flexed posture Abundant lanugo usually is seen on preterm infants Smooth pink skin with visible veins is seen on preterm infants

Related Books