What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?

Assess the parents' anxiety level and readiness to learn.

Gather literature for the parents.

Secure a quiet place for teaching.

Discuss the plan with the nursing team.

Answer and Explanation

The Correct Answer is A

Choice A rationale:
Assessing the parents' anxiety level and readiness to learn is the first action when planning to teach the parents of an infant with a congenital heart defect (CHD). Understanding the parents' emotional state and readiness to receive information is crucial in tailoring the teaching approach effectively.
Choice B rationale:
Gathering literature for the parents is a valuable resource, but it should come after assessing the parents' needs and readiness to learn. Providing information without considering the parents' emotional state and readiness may not be as effective.
Choice C rationale:
Securing a quiet place for teaching is important for minimizing distractions, but it is not the first action. Assessing the parents' readiness to learn comes before setting up the teaching environment.
Choice D rationale:
Discussing the plan with the nursing team is important for coordination, but it is not the first action. Assessing the parents' emotional state and readiness to learn guides the development of an effective teaching plan.

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Correct Answer is ["A","C","D","E"]

Explanation

The correct answer ischoices A, C, D, and E.

Choice A rationale:

A respiratory rate of 36 breaths/minute at rest is concerning in a pediatric client, as it may indicate respiratory distress or an underlying respiratory condition.

Choice B rationale:

An increasing appetite is generally a positive sign and not typically concerning unless accompanied by other symptoms.

Choice C rationale:

A temperature above 37.7° C (100° F) is concerning as it indicates fever, which could be a sign of infection or other medical conditions.

Choice D rationale:

New, frequent coughing is concerning as it may indicate respiratory infections, asthma, or other respiratory issues.

Choice E rationale:

Turning blue or bluer than normal (cyanosis) is a serious symptom indicating inadequate oxygenation and requires immediate medical attention.

A. Most mothers have a diet deficient in vitamin K, which results in the infant's being deficient. B. Vitamin K prevents the synthesis of prothrombin in the liver and must be given by injection. C. Bacteria that synthesize vitamin K are not present in the newborn's intestinal tract. D. The supply of vitamin K is inadequate for at least 3 to 4 months, and the newborn must be supplemented.

Correct Answer is C

Explanation

Choice A rationale:

Most mothers do not have a diet deficient in vitamin K that would result in the infant being deficient. Vitamin K is essential for blood clotting, and it is generally present in adequate amounts in a well-balanced diet.

Choice B rationale:

Vitamin K does play a role in the synthesis of prothrombin, a clotting factor in the liver, but it is not the primary reason for administering vitamin K to newborns. The main reason is the absence of vitamin K-synthesizing bacteria in the newborn's intestinal tract.

Choice C rationale:

The correct answer. Newborns do not have the bacteria in their intestines necessary to produce vitamin K, which is crucial for blood clotting. Without sufficient vitamin K, newborns are at risk of bleeding disorders, including a potentially fatal condition called vitamin K deficiency bleeding (VKDB).

Choice D rationale:

While it's true that the supply of vitamin K from the mother to the baby is limited during pregnancy and breastfeeding, the main reason for administering vitamin K to newborns is the absence of bacteria that can synthesize vitamin K in the infant's intestinal tract.

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What is the nurse's first action when planning to teach the parents of an infant with a congenital heart defect (CHD)?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is conducting discharge teaching to parents about the care of their infant after cardiac surgery. The nurse instructs the parents to notify the physician of what conditions occur. (Select all that apply.).

Correct Answer is ["A","C","D","E"]

Explanation

The nurse administers vitamin K to the newborn for which reason?

Correct Answer is C

Explanation

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