As relates to rubella and Rh issues, nurses should be aware that:.

Breastfeeding mothers cannot be vaccinated with the live attenuated rubella virus.

Women should be warned that the rubella vaccination is teratogenic and that they must avoid pregnancy for 1 month after vaccination.

Rh immune globulin is safely administered intravenously because it cannot harm a nursing infant.

Rh immune globulin boosts the immune system and thereby enhances the effectiveness of vaccinations.

Answer and Explanation

The Correct Answer is B

The presence or absence of anxiety is a noninvasive assessment that the RN would perform to evaluate the patient’s psychological status and possible signs of hypovolemic shock.

Anxiety can indicate reduced cerebral perfusion due to blood loss and low blood pressure.

Choice A is wrong because pulse oximetry is a noninvasive assessment that the RN would perform to measure the oxygen saturation of the patient’s blood, not the circulatory status.

Choice B is wrong because heart sounds are a noninvasive assessment that the RN would perform to auscultate the cardiac rhythm and rate of the patient, not the circulatory status.

Choice C is wrong because arterial pulses are a noninvasive assessment that the RN would perform to palpate the strength and quality of the patient’s peripheral pulses, not the circulatory status.

Choice D is wrong because skin color, temperature, and turgor are noninvasive assessments that the RN would perform to observe the skin integrity and hydration of the patient, not the circulatory status.

Normal ranges for pulse oximetry are 95% to 100%, for heart rate, are 60 to 100 beats per minute, and for blood pressure are 120/80 mmHg.

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Correct Answer is D

Explanation

choice D. Make a follow-up home visit to parents as soon as possible after the infant’s death. This is because a competent, qualified professional should visit the family at home as soon as possible after the death and provide the family with printed information about SIDS.

Choice A is wrong because explaining how SIDS could have been predicted and prevented is inappropriate.

SIDS cannot be prevented or predicted. Discussions about the cause will only increase parental guilt.

Choice B is wrong because the parents should be asked only factual questions to determine the cause of death. Interviewing parents in-depth concerning the circumstances surrounding the infant’s death may be intrusive and stressful.

Choice C is wrong because parents should be allowed and encouraged to make a last visit with their infant. Discouraging parents from making a last visit with the infant may deprive them of an opportunity to say goodbye and grieve.

A. Correction of acidosis B. Adequate hydration. C. Pain management. D. Administration of heparin.

Correct Answer is ["B","C"]

Explanation

The child’s care should include adequate hydration and pain management. The management of an acute event of a vaso-occlusive crisis is the use of potent analgesics (opioids), rehydration with normal saline or Ringer’s lactate, treatment of malaria (whether symptomatic or not) using artemisinin combination therapy, and the use of oxygen via face mask, especially for acute chest syndrome.

Choice A is wrong because correction of acidosis is not a specific intervention for the vaso- occlusive crisis.

Acidosis may occur as a complication of sickle cell disease, but it is not the primary cause of the crisis.

Choice D is wrong because the administration of heparin is not recommended for the vaso-occlusive crisis.

Heparin is an anticoagulant that may increase the risk of bleeding and does not prevent or treat the sickling process.

Normal ranges for hemoglobin are 11.5 to 15.5 g/dl for children after 2 years of age.

Normal ranges for reticulocyte count are 0.5% to 1.5% for adults and 0.5% to 2.5% for children.

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As relates to rubella and Rh issues, nurses should be aware that:.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is an important nursing responsibility when dealing with a family experiencing the loss of an infant from sudden infant death syndrome (SIDS)?

Correct Answer is D

Explanation

A school-age child is admitted in vaso-occlusive sickle cell crisis. The child’s care should include which intervention? (Select all that apply.)

Correct Answer is ["B","C"]

Explanation

An Apgar score of 10 at 1 minute after birth would indicate a(n):

The nurse is meeting a 5-year-old child for the first time and would like the child to cooperate during a dressing change. The nurse decides to do a simple magic trick using gauze. This should be interpreted as:

Nurses can prevent evaporative heat loss in the newborn by:

When caring for an infant with an upper respiratory tract infection and elevated temperature, which appropriate nursing intervention should the nurse implement?

What should a nurse advise the parents of a child with type 1 diabetes mellitus who is not eating as a result of a minor illness?

The nurse is assessing a child with acute epiglottitis. Examining the child’s throat by using a tongue depressor might precipitate which symptom or condition?

A premature infant with respiratory distress syndrome receives artificial surfactant. How would the nurse explain surfactant therapy to the parents?