A nurse is reinforcing teaching about vitamin K with a client who is postpartum. Which of the following statements should the nurse include in the teaching?
Vitamin K decreases the newborn’s risk of health care-associated infections.
Vitamin K decreases the newborn’s risk of jaundice.
Vitamin K decreases the newborn’s risk of complications from the Hepatitis B vaccine.
Vitamin K decreases the newborn’s risk of hemorrhagic disorders.
The Correct Answer is D
Choice A reason: This statement is incorrect. Vitamin K does not have any effect on the newborn’s risk of health care-associated infections. Vitamin K is needed for blood clotting, not for fighting infections.
Choice B reason: This statement is incorrect. Vitamin K does not have any effect on the newborn’s risk of jaundice. Jaundice is caused by high levels of bilirubin in the blood, not by low levels of vitamin K.
Choice C reason: This statement is incorrect. Vitamin K does not have any effect on the newborn’s risk of complications from the Hepatitis B vaccine. Vitamin K is not involved in the immune response to the vaccine.
Choice D reason: This statement is correct. Vitamin K decreases the newborn’s risk of hemorrhagic disorders, such as vitamin K deficiency bleeding (VKDB). VKDB is a rare but serious condition that can cause bleeding in the brain or other organs. VKDB is more common in newborns who are breastfed, premature, or have liver problems. Vitamin K is given to all newborns as an injection or oral dose to prevent VKDB.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: This statement is false. The Babinski reflex is when the newborn fans out the toes and curls the big toe upward when the sole of the foot is stroked. It is not related to sucking and disappears by 2 years of age.
Choice B reason: This statement is true. The rooting reflex is when the newborn turns the head and opens the mouth to follow and root in the direction of the stroking on the cheek or corner of the mouth. It helps the newborn find the breast or bottle to start sucking and lasts about 4 months.
Choice C reason: This statement is false. The stepping reflex is when the newborn appears to take steps or dance when held upright with the feet touching a solid surface. It is not related to sucking and lasts about 2 months.
Choice D reason: This statement is false. The Moro reflex is when the newborn extends the arms and legs, opens the hands, and then draws the arms together as if embracing when startled by a loud sound or movement. It is not related to sucking and lasts about 5 to 6 months.
Correct Answer is D
Explanation
Choice A reason: This statement is false. Applying cold compresses is not a recommended intervention for the client who has pain, swelling, and redness of the calf. These symptoms could indicate deep vein thrombosis (DVT), which is a blood clot in the leg. Cold compresses can increase the risk of clotting and worsen the condition.
Choice B reason: This statement is false. Massaging the area is not a recommended intervention for the client who has pain, swelling, and redness of the calf. These symptoms could indicate DVT, which is a blood clot in the leg. Massaging the area can dislodge the clot and cause it to travel to the lungs, resulting in a pulmonary embolism, which is a life-threatening complication.
Choice C reason: This statement is false. Flexing the knee while resting is not a recommended intervention for the client who has pain, swelling, and redness of the calf. These symptoms could indicate DVT, which is a blood clot in the leg. Flexing the knee can increase the pressure on the vein and aggravate the pain and swelling.
Choice D reason: This statement is true. Elevating the leg is a recommended intervention for the client who has pain, swelling, and redness of the calf. These symptoms could indicate DVT, which is a blood clot in the leg. Elevating the leg can reduce the swelling and improve the blood flow. However, this is not a substitute for medical treatment, and the client should see the provider as soon as possible.
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