A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy.
Which of the following instructions should the nurse include?

Cleanse the perineal area from back to front.

Wash the perineal area with povidone-iodine twice daily.

Change the perineal pad with each void.

Wipe the perineal area with a soft towel.

Answer and Explanation

The Correct Answer is C

A.   Cleansing the perineal area from back to front can introduce bacteria from the rectum to the urinary tract, increasing the risk of infection. Front to back is the recommended direction for cleansing.
B.   Washing the perineal area with povidone-iodine twice daily may be too frequent and could potentially irritate the area. Gentle cleansing with warm water is typically recommended.
C.   Changing the perineal pad with each void helps to maintain cleanliness and prevent infection by reducing the buildup of moisture and bacteria.
D.   Wiping the perineal area with a soft towel is appropriate for gentle cleansing but does not address the importance of changing the perineal pad regularly.

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Correct Answer is B

Explanation

A. Incorrect. Lip smacking is not typically associated with pain in newborns and may indicate hunger or a self-soothing behavior.
B. Correct. Diaphoresis, or sweating, can be a sign of pain in newborns following circumcision. C. Incorrect. Hypoglycemia refers to low blood glucose levels and is not a direct manifestation of pain.
D. Incorrect. Transient strabismus, or crossed eyes, is not typically associated with pain in newborns and may be a normal variation.

A. "You can take your child to stores on weekends." B. "You should inspect your child's mouth weekly for ulcers." C. "You should notify your provider if your child has a fever." D. "You can give your child fresh fruit for snacks."

Correct Answer is C

Explanation

A. "You can take your child to stores on weekends." Neutropenic clients are at increased risk of infection, so avoiding crowded places like stores is advisable.
B. "You should inspect your child's mouth weekly for ulcers." Neutropenic clients are at risk of developing oral mucositis, so mouth inspections should be performed daily, not weekly.
C. "You should notify your provider if your child has a fever." Neutropenic clients are at high risk of infection-related complications, and fever can be an early sign of infection. Prompt notification of healthcare providers is essential for timely intervention.
D. "You can give your child fresh fruit for snacks." Neutropenic clients should avoid fresh fruits and vegetables that cannot be peeled or cooked, as they may harbor bacteria that can cause infection.

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A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy. Which of the following instructions should the nurse include?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a newborn following a circumcision. Which of the following manifestations indicates the newborn is experiencing pain?

Correct Answer is B

Explanation

A nurse is reinforcing discharge teaching with the guardian of a client who is neutropenic. Which of the following instructions should the nurse include?

Correct Answer is C

Explanation

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A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an episiotomy.
Which of the following instructions should the nurse include?