A nurse is obtaining the temperature of a newborn. Which of the following sites should the nurse use?

Tympanic

Oral

Axillary

Rectal

Answer and Explanation

The Correct Answer is C

A. Tympanic thermometers are not recommended for newborns because the ear canal is difficult to assess accurately in this age group.

B. Oral temperatures are not recommended for newborns due to the difficulty in ensuring accuracy.

C. The axillary site is the recommended method for obtaining a newborn's temperature. It is safe and non-invasive.

D. Rectal temperatures are accurate but are invasive and may cause discomfort or injury. It should only be used if other methods are not feasible.

Nursing Test Bank

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Correct Answer is D

Explanation

A. Assigning tasks is important but comes after understanding family dynamics.

B. Establishing a routine is beneficial but should follow assessment.

C. Referring to a support group is valuable but not the immediate first step.

D. Determining family roles helps the nurse assess coping strategies and dynamics, which is essential before planning interventions.

A. Ask the client about the content of their hallucinations. B. Instruct the client on expected hygiene practices. C. Allow the client to watch TV at a high volume. D. Assess the client for suicidal ideation. E. Place the client in a room near the activity

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

Potential action	Indicated	Contraindicated
Ask the client about the content of their hallucinations.	✓
Instruct the client on expected hygiene practices.	✓
Allow the client to watch TV at a high volume.		✓
Assess the client for suicidal ideation.	✓
Place the client in a room near the activity		✓

Rationale

Ask the client about the content of their hallucinations: Indicated
- Understanding the content of hallucinations can help in assessing the severity and nature of the client's condition, and in planning appropriate interventions.
Instruct the client on expected hygiene practices: Indicated
- Encouraging and educating the client about personal hygiene is important for their overall well-being and social interactions.
Allow the client to watch TV at a high volume: Contraindicated
- High volume and excessive stimulation can exacerbate symptoms of schizophrenia, such as hallucinations and agitation.
Assess the client for suicidal ideation: Indicated
- Regular assessment for suicidal thoughts is crucial, even if the client initially denies them, as their mental state can change.
Place the client in a room near the activity: Contraindicated
- A quieter environment is generally more beneficial for clients with schizophrenia to reduce overstimulation and stress.

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A nurse is obtaining the temperature of a newborn. Which of the following sites should the nurse use?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A community health nurse is working with a family that is struggling to adapt following the loss of a family member. Which of the following actions should the nurse take first?

Correct Answer is D

Explanation

A nurse is caring for a client on a psychiatric unit. Exhibits For each potential action, click to specify if the action is indicated or contraindicated for the client.

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"A"},"C":{"answers":"B"},"D":{"answers":"A"},"E":{"answers":"B"}}

Explanation

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