A nurse is providing teaching to a client who reports that her baby has yellow discharge forming at the circumcision site. Which of the following is an appropriate response by the nurse?
"I will need to obtain a sample of the discharge for laboratory testing.".
"Apply povidone-iodine solution twice daily to the circumcision site.".
"Wipe the discharge away gently with a washcloth and warm water for the next 48 hours.".
"The discharge is common during the first 24 to 72 hours following a circumcision.".
The Correct Answer is D
Choice A rationale:
The nurse does not need to obtain a sample of the discharge for laboratory testing at this point. Yellow discharge after circumcision is common and generally not a cause for immediate concern. Laboratory testing is not necessary for routine circumcision care.
Choice B rationale:
Applying povidone-iodine solution twice daily to the circumcision site is not recommended in this situation. Povidone-iodine may cause irritation and delay the natural healing process.
Generally, no specific cleaning solution is required for circumcision care unless otherwise indicated by a healthcare provider.
Choice C rationale:
Wiping the discharge away gently with a washcloth and warm water for the next 48 hours is not the most appropriate action. The circumcision site should be kept clean and dry, but actively wiping away the discharge may cause irritation and disrupt the natural healing process.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Bright, red vaginal discharge is not a typical manifestation of an ectopic pregnancy. Instead, it can be indicative of other conditions such as miscarriage or vaginal bleeding.
Choice B rationale:
A scaphoid abdomen is not a typical manifestation of an ectopic pregnancy. A scaphoid abdomen is seen in cases of diaphragmatic hernia, where the abdominal organs move into the chest cavity, leaving the abdomen with a sunken appearance.
Choice C rationale:
Elevated blood pressure is not a typical manifestation of an ectopic pregnancy. High blood pressure can be associated with conditions like preeclampsia but is not specifically linked to ectopic pregnancies.
Choice D rationale:
Sharp pelvic pain is a common manifestation of an ectopic pregnancy. As the fertilized egg implants outside the uterus, often in the fallopian tube, it can cause pain and discomfort.
Correct Answer is B
Explanation
Choice A rationale:
Requesting that the provider insert an intrauterine pressure catheter is not the immediate action the nurse should take when the umbilical cord is palpated during a vaginal examination. The priority is to relieve pressure on the cord and improve fetal oxygenation.
Choice B rationale:
Exerting continuous upward pressure on the presenting part is the correct action when the nurse palpates the umbilical cord during a vaginal examination. This manoeuvre is called "vaginal elevation,”. helps lift the presenting part off the umbilical cord, reducing the risk of cord compression and fetal distress until the provider can take further action.
Choice C rationale:
Initiating oxytocin via continuous IV infusion is not appropriate when the umbilical cord is palpated during a vaginal examination. Oxytocin can cause uterine contractions, potentially further compromising the cord and fetus.
Choice D rationale:
Placing the client in the left-lateral position is not the best immediate action for cord palpation. While the left-lateral position is useful for relieving pressure on the vena cava in cases of supine hypotensive syndrome, the priority here is to relieve cord compression, and upward pressure on the presenting part is more effective.
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