A nurse is conducting discharge and teaches parents about the care of their infant after cardiac surgery.
The nurse instructs the parents to notify the physician if the conditions occur. (Select all that apply.)
Respiratory rate of 36 breaths/minute at rest
Appetite slowly increasing
Temperature above 37.7° C (100° F)
New, frequent coughing
Turning blue or bluer than normal
Correct Answer : C,D,E
The parents should notify the physician if the infant has a temperature above 37.7° C (100° F), new frequent coughing, or turning blue or bluer
than normal. These are signs of infection, respiratory distress, or cyanosis, which could indicate complications after cardiac surgery.
Choice A is wrong because a respiratory rate of 36 breaths/minute at rest is within the normal range for an infant.
Choice B is wrong because an appetite slowly increasing is a positive sign of recovery and does not require immediate attention.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
This is because oil peppermint can stimulate the micturition reflex and help the woman to void.
Some possible explanations for the other choices are:
Choice A is wrong because pouring water over the perineum may not be enough to trigger the micturition reflex and may cause discomfort or infection.
Choice C is wrong because analgesics may not address the underlying cause of urinary retention and may have side effects such as drowsiness or nausea.
Choice D is wrong because inserting a sterile catheter is an invasive procedure that carries risks such as trauma, infection, or bladder spasms. It should be used only as a last resort after other methods have failed.
Normal ranges for postpartum bladder function are:
- Urine output: 3000 to 5000 mL/day for the first 2 to 3 days after delivery.
- Urine specific gravity: 1.005 to 1.030.
- Urine pH: 4.6 to 8.0.
Correct Answer is ["A","C","D","E","F"]
Explanation
A health history is a holistic assessment of all factors affecting a patient’s health status, including information about social, cultural, familial, and economic aspects of the patient’s life as well as any other component of the patient’s life style that affects health and well-being.
Choice B is wrong because physical assessment is not part of the health history, but a separate process of examining the patient’s body systems.
Choice A is correct because review of systems is a systematic method of collecting data on all body systems.
Choice C is correct because sexual history is an important aspect of the patient’s health that may affect their risk for sexually transmitted infections, reproductive health, and psychosocial well-being.
Choice D is correct because height, weight, BMI data are part of the biographical data that provide a baseline for comparing the patient’s characteristics to established norms for physical and emotional health.
Choice E is correct because diet and nutritional intake are relevant factors that influence the patient’s health status and may indicate potential problems such as malnutrition, obesity, or eating disorders.
Choice F is correct because family medical history provides information about the patient’s genetic risk for certain diseases and conditions that may affect their current or future health.
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