A nurse is caring for a newborn following delivery. Which of the following actions should the nurse take first?
Obtain the newborn's weight.
Administer IM vitamin K.
Apply identification bands to the newborn.
Apply prophylactic eye ointment.
The Correct Answer is C
Identification bands are an important safety measure to ensure that the newborn is properly identified and matched with the correct mother. Applying identification bands to the newborn and mother is a standard practice in all healthcare settings and is typically done immediately following delivery.
While obtaining the newborn's weight, administering IM vitamin K, and applying prophylactic eye ointment are also important interventions for a newborn, they should be done after the identification bands are applied. The order of priority for these interventions may vary depending on the healthcare facility's policies and procedures, but ensuring proper identification of the newborn is always the first step to ensure patient safety.
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Related Questions
Correct Answer is C
Explanation
The nurse should include in the teaching that clients who use a diaphragm for birth control should have an annual examination to assess its fit and effectiveness. The nurse should also educate clients on the proper use and care of the diaphragm.
Spermicide should be used no more than 30 minutes prior to sexual intercourse, not 3 hours prior.
Emergency contraception does not provide ongoing protection against pregnancy, so clients will need to use another form of birth control immediately after taking the medication.
Fertility can return quickly after the removal of an IUD, usually within a few weeks to a month.
Correct Answer is B
Explanation
Constipation is a common problem for clients who have recently given birth, and suppositories are a common treatment option for constipation. However, suppositories are not appropriate for all clients. Certain conditions can be a contraindication to the use of suppositories, and the nurse should be aware of these conditions.
The nurse should identify that a third-degree perineal laceration is a contraindication to the use of a suppository, as it may cause further trauma to the already injured area. In this case, alternative treatments such as stool softeners or oral laxatives may be more appropriate for the client.
Option A is incorrect because although abdominal distention can be a sign of constipation, it is not a contraindication to the use of a suppository.
Option C is also incorrect because vaginal candidiasis is not a contraindication to the use of a suppository. In fact, suppositories are sometimes used to treat vaginal candidiasis.
Option D is also incorrect because afterpains are not a contraindication to the use of a suppository.
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