A client who is 38 weeks pregnant is concerned her baby might get a communicable disease before any immunizations are given.

Which physiological mechanism should the nurse use when responding to the mother's concerns?

Infants can receive antibodies through breast milk that help fight infections.

The infant's immune system may be immature in protecting against infections.

Immunity in the first months of life provides protection.

Active immunity in newborns is fully developed in the first month of life.

Answer and Explanation

Correct Answer : A,B,C

Choice A rationale

Breast milk contains antibodies, specifically Immunoglobulin A (IgA), which provide passive immunity to infants and help in fighting off infections. This protective mechanism is especially important in the early months when the infant's immune system is still developing.

Choice B rationale

The immune system of a newborn is immature, particularly in its ability to produce its own antibodies. This immaturity means that newborns rely on passive immunity from the mother, either through the placenta during pregnancy or via breast milk after birth.

Choice C rationale

Infants possess passive immunity during the first few months of life, derived from maternal antibodies transferred through the placenta. This temporary immunity provides a crucial defense against infections until the infant's own immune system becomes more developed and capable of responding to pathogens.

Choice D rationale

While newborns have some level of immune function, it is not fully developed within the first month of life. Active immunity, the body's ability to produce its own antibodies in response to pathogens, takes several months to fully mature. .

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Correct Answer is C

Explanation

Choice A rationale

Requesting extra staff to help with the nursing assessments may not be the most effective approach. It could increase the child's anxiety due to the presence of more unfamiliar people in the room. The primary goal is to create a calm environment that helps the child feel safe and more cooperative.

Choice B rationale

Explaining the reasons for the examination to the child may not be effective for a preschooler who may not fully understand or be comforted by such explanations. Young children often require more tangible and immediate means of reassurance and distraction.

Choice C rationale

Talking to the mother and gradually focusing on the child's toy is a practical approach. This strategy helps build rapport with both the mother and the child, and using the toy as a focal point can distract and comfort the child, making the examination process less intimidating and more cooperative.

Choice D rationale

Completing the assessment while allowing the child to cry may not be ideal. It can increase the child's distress and make the assessment more challenging. Addressing the child's emotional needs by providing comfort and distraction can lead to a more successful and less stressful examination.

A. These findings are within normal limits and require routine follow-up. B. All findings are outside of the acceptable range and should be reported to the healthcare provider immediately. C. The primary IV fluids should be increased to assist in increasing the urinary output. D. The findings indicate potential toxicity to the magnesium sulfate and close follow-up is indicated.

Correct Answer is B

Explanation

Choice A rationale

While routine follow-up is necessary, these findings suggest magnesium sulfate toxicity, requiring immediate attention beyond routine monitoring. Hence, this is not the correct action.

Choice B rationale

Although reporting abnormal findings to the healthcare provider is critical, not all findings are necessarily outside acceptable ranges. This choice lacks the specificity needed in this context, making it less appropriate.

Choice C rationale

Increasing primary IV fluids could help with low urine output but would not address potential magnesium toxicity, which is the primary concern indicated by the assessment. Therefore, it is not the correct conclusion.

Choice D rationale

The findings suggest magnesium toxicity, including decreased respirations, reduced urine output, and deep tendon reflexes. Close follow-up, including immediate medical intervention, is needed to manage this potential toxicity.

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A client who is 38 weeks pregnant is concerned her baby might get a communicable disease before any immunizations are given. Which physiological mechanism should the nurse use when responding to the mother's concerns?

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Naxlex Comprehensive Predictor Exams

A mother brings her male preschooler to the clinic because he has had diarrhea, vomiting, and high fevers for the past three days. The child begins to cry and cling to his mother when the nurse enters the examination room. Which action should the nurse implement to get the child to cooperate?

Correct Answer is C

Explanation

Correct Answer is B

Explanation

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A client who is 38 weeks pregnant is concerned her baby might get a communicable disease before any immunizations are given.

Which physiological mechanism should the nurse use when responding to the mother's concerns?