A nurse is caring for a 36-hr old infant.
For each nursing action, click to specify if the action is indicated or contraindicated for the newborn.
Apply lotion to skin every 4 hr.
Supplement feeding with sterile water.
Brestfeed every 2 to 3 hr.
Cover newborn's eyes with a shield.
Dress in only a diaper.
The Correct Answer is {"A":{"answers":"B"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}
A. Applying lotion to the skin is contraindicated during phototherapy because it can interfere with the effectiveness of the therapy by blocking the light from reaching the skin. B. Supplementing feeding with sterile water is contraindicated because it can decrease the newborn's intake of breast milk or formula, which is essential for hydration and nutrition, especially during phototherapy. C. Breastfeeding is indicated and encouraged every 2 to 3 hours because it helps to maintain hydration and promotes bilirubin excretion, which can help in reducing jaundice levels. D. Covering the newborn's eyes with a shield is indicated during phototherapy to protect the eyes from the bright lights used in the treatment, which can potentially damage the retina and cause eye problems. E. Dressing the newborn in only a diaper is indicated during phototherapy to maximize the exposure of the skin to the light, which enhances the effectiveness of the treatment in reducing bilirubin levels.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Limiting intake of dairy products may not directly address stomatitis unless the client has an intolerance or allergy to dairy.
B. Using a soft-bristle toothbrush helps prevent trauma to the oral mucosa, which can exacerbate stomatitis. Gentle oral care with a soft toothbrush after meals helps maintain oral hygiene without causing further irritation.
C. Moistening lips with lemon-glycerin swabs may further irritate the oral mucosa due to the acidic nature of lemon.
D. Gargling with an alcohol-based mouthwash can exacerbate stomatitis and should be avoided due to its drying effect on oral tissues.
Correct Answer is C
Explanation
A. While this may be a risk factor for some behaviors, it is not as strong a predictor of violence as a history of actual violent behavior.
B. Although statistics show higher rates of violence among males, it's not a specific predictor for individual behavior.
C. Previous violent behavior is the strongest predictor of future violence.
Understanding a client's history of violence is critical in assessing risk and planning interventions.
D. While certain types of delusions may increase risk, they are not as definitive in predicting violence as past violent behaviors.
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