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A nurse is teaching a newborn’s parent to care for the umbilical cord stump. Which of the following instructions should the nurse include?

Cover the cord with the diaper.

Wash the cord daily with mild soap and water.

Apply petroleum jelly to the cord stump.

Give a sponge bath until the cord stump falls off.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Covering the cord with the diaper can create a moist environment that promotes bacterial growth and delays healing.

Choice B rationale

Washing the cord daily with mild soap and water is not recommended. It’s better to keep the cord dry and clean.

Choice C rationale

Applying petroleum jelly to the cord stump is not advised. It can create a moist environment that can delay the drying and falling off of the stump.

Choice D rationale

Giving a sponge bath until the cord stump falls off is the correct instruction. This prevents the stump from getting wet, which can delay healing and increase the risk of infection.

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Correct Answer is C

Explanation

Choice A rationale

While providing age-appropriate stimulation is important for all newborns, it is not the priority nursing goal in caring for a newborn with a myelomeningocele awaiting surgery.

Choice B rationale

Educating the parents about the defect is an important part of care, but it is not the priority nursing goal. The immediate physical needs of the newborn take precedence.

Choice C rationale

This is the correct answer. The sac covering the exposed neural tissue must be carefully protected to prevent infection and further damage. Therefore, maintaining the integrity of the sac is the priority nursing goal.

Choice D rationale

Promoting maternal-infant bonding is important, but it is not the priority nursing goal in caring for a newborn with a myelomeningocele awaiting surgery.

A. Pattern of contractions B. Changes in the cervix C. Rupture of the membranes D. Station of the presenting part .

Correct Answer is B

Explanation

Choice A rationale

While a pattern of contractions can be a sign of labor, it is not the definitive sign of true labor. Contractions may also occur in false labor, also known as Braxton Hicks contractions. These contractions do not lead to changes in the cervix.

Choice B rationale

Changes in the cervix, including effacement (thinning) and dilation (opening), are the definitive signs of true labor. During true labor, contractions lead to progressive changes in the cervix, which allow for the baby to be born.

Choice C rationale

Rupture of the membranes, or “water breaking,” can occur in both true labor and false labor. Therefore, it is not the definitive sign of true labor.

Choice D rationale

The station of the presenting part refers to the position of the baby’s head (or other presenting part) in relation to the mother’s pelvis. While the station can change during labor as the baby descends into the pelvis, it is not the definitive sign of true labor.

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A nurse is teaching a newborn’s parent to care for the umbilical cord stump. Which of the following instructions should the nurse include?

Choice B rationale

Choice C rationale

Choice D rationale

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a newborn who has myelomeningocele. Which of the following nursing goals has the priority in the care of this infant?

Correct Answer is C

Explanation

Choice B rationale

Choice C rationale

Choice D rationale

A nurse is caring for a client who is a primigravida, at term, and having contractions but is unsure if she is in labor. Which of the following should the nurse recognize as a sign of true labor?

Correct Answer is B

Explanation

Choice A rationale

Choice B rationale

Choice C rationale

Choice D rationale

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