A nurse is observing an adolescent client who is oﬀering her newborn a botle while he is lying in the bassinet. When the nurse oﬀers to pick the newborn up and place him in the client’s arms, the mother states, “No, the baby is too tired to be held.”

Which of the following actions should the nurse take?

Oﬀer to take the newborn to the nursery to finish his feeding

Insist that the mother pick up the newborn to feed him

Demonstrate how to hold the newborn and allow the client to practice

Persuade the client to breastfeed the newborn to promote bonding

Answer and Explanation

The Correct Answer is C

This option respects the mother's wishes of not wanting to hold the newborn while also allowing the nurse to provide education on safe and appropriate feeding positions. It also gives the mother the opportunity to learn and practice holding the newborn in a safe way.

Option a, oﬀering to take the newborn to the nursery, may not be necessary as the mother is already oﬀering the baby a botle.

Option b, insisting that the mother pick up the newborn, would not be respectful of her wishes and could potentially damage the trust and rapport between the mother and nurse.

Option d, persuading the client to breastfeed, may not be appropriate or feasible in this situation as it may not be the mother's preferred feeding method and may not address the immediate concern of the newborn being too tired to be held.

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Correct Answer is D

Explanation

New onset tachypnea in a newborn is a concerning symptom and requires immediate assessment by the nurse. Tachypnea is defined as a respiratory rate greater than 60 breaths per minute in a newborn. It can be a sign of respiratory distress or other serious conditions, such as sepsis or cardiac disease.

Option a. A newborn who has a short frenulum and is having difficulty breastfeeding is a common issue that can be addressed by the nurse or lactation consultant. It does not require immediate assessment.

Option b. A newborn who is 24 hr old and has not had a meconium stool may be concerning, but it is not an emergency situation. It may be a sign of a bowel obstruction, but it is not an urgent condition.

Option c. A newborn who is 10 hr old and has blood-tinged discharge in her diaper may be a concerning symptom, but it is not an emergency situation. It may be related to maternal hormones and is a common finding in newborns.

Therefore, the correct option is d. A newborn who is 10 hr old and has new onset tachypnea. The nurse should assess the newborn's respiratory status, heart rate, and oxygen saturation and notify the healthcare provider immediately if there are any concerns.

A. Abdominal distention B. Third-degree perineal laceration C. Vaginal candidiasis D. Afterpain

Correct Answer is B

Explanation

Constipation is a common postpartum issue due to decreased bowel motility, dehydration, and fear of pain during defecation. Suppositories are a common treatment option to help relieve constipation in postpartum clients. However, there are certain contraindications to the use of suppositories.

Option A, abdominal distention, is not a contraindication to the use of a suppository, as it can help relieve the distention and promote bowel movement.

Option C, vaginal candidiasis, is also not a contraindication to the use of a suppository. In fact, antifungal suppositories may be prescribed to treat the candidiasis.

Option D, afterpain, is not a contraindication to the use of a suppository, as afterpains are normal

postpartum contractions that occur as the uterus returns to its pre-pregnancy size.

Option B, third-degree perineal laceration, is a contraindication to the use of a suppository. The suppository can cause further trauma to the already injured perineal area and delay the healing process. In this case, alternative treatment options, such as stool softeners or laxatives, should be considered.

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Naxlex Comprehensive Predictor Exams

A nurse in a newborn nursery is receiving change-of-shift report for four newborns. Which of the following newborns should the nurse assess first?

Correct Answer is D

Explanation

A nurse is reviewing the chart of a client who is 2 days postpartum following a vaginal delivery and reports constipation. Which of the following findings should the nurse identify as a contraindication to the use of a suppository?

Correct Answer is B

Explanation

A nurse is providing teaching to a client who is receiving medroxyprogesterone IM for contraception. Which of the following statements by the client indicates an understanding of the teaching?

A nurse is caring for a client who has pregestational diabetes mellitus. Which of the following clinical findings should indicate to the nurse that the client has hyperglycemia?

A nurse is assessing a client who is at 32 weeks of gestation and is receiving magnesium sulphate via continuous IV infusion. Which of the following findings should the nurse report to the provider?

A nurse is assessing a newborn whose mother had a primary cytomegalovirus (CMV) infection during pregnancy. The newborn acquired CMV transplacentally. Which of the following findings should the nurse expect the newborn to exhibit?

A nurse is caring for a client who is postpartum and experiencing hypovolemic shock. Which of the following findings should the nurse expect?

A nurse is assessing the results of a nonstress test for an antepartum client at 35 weeks of gestation. Which of the following findings should indicate to the nurse the need for further diagnostic testing?

A nurse is planning care for a client who is pregnant and has HIV. Which of the following actions should the nurse include in the plan of care?