A nurse is caring for a client who asks why her newborn is receiving a phytonadione injection. Which of the following statements should the nurse make?
This medication prevents your baby from developing bleeding problems."
"This medication enhances regulation of your baby's temperature."
"This medication enhances your baby's immune response."
"This medication prevents your baby from developing jaundice
The Correct Answer is A
Choice A Reason:
"This medication prevents your baby from developing bleeding problems." This is the correct statement. Phytonadione is given to newborns to prevent neonatal vitamin K deficiency bleeding (VKDB), which can lead to serious bleeding problems, including intracranial hemorrhage.
Choice B Reason:
"This medication enhances regulation of your baby's temperature." Phytonadione does not have any direct impact on the regulation of a baby's temperature. Its primary purpose is to prevent bleeding issues.
Choice C Reason:
"This medication enhances your baby's immune response. Phytonadione does not enhance a baby's immune response. It primarily addresses vitamin K deficiency and associated bleeding risks.
Choice D Reason:
"This medication prevents your baby from developing jaundice." Phytonadione is not used to prevent jaundice. Jaundice is typically related to bilirubin levels and is managed separately from vitamin K supplementation.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
This is an essential instruction for performing passive ROM exercises safely and effectively. Supporting the extremity above and below each joint helps to prevent injury and provides stability during the exercise. This technique also helps to minimize discomfort and maintain proper alignment of the joint.
Repeat each exercise movement 10 times: This instruction does not provide sufficient guidance on the number of repetitions and may be too general. The number of repetitions will depend on the client's condition and tolerance.
Position the bed at mid-thigh level: This instruction is not necessary for performing passive ROM exercises and may not be feasible in all settings.
Move each joint just past the point of resistance: This instruction can be harmful and may cause injury or pain. The nurse should encourage the family to move the joint gently and smoothly, within the range of motion that is comfortable for the client.
Correct Answer is C
Explanation
Choice A Reason:
"Sounds are soft and at a rate of 1/min" - This describes hypoactive bowel sounds, which are characterized by decreased motility, not hyperactive bowel sounds.
Choice B Reason:
"Indicates decreased motility" - This is a correct statement about hypoactive bowel sounds, not hyperactive bowel sounds.
Choice C Reason:
Sounds are high-pitched. Hyperactive bowel sounds are characterized by sounds that are loud and high-pitched. These sounds are often more frequent and rapid than normal bowel sounds, indicating increased motility of the gastrointestinal tract. Hyperactive bowel sounds can be associated with conditions like diarrhea or early bowel obstruction and are the opposite of hypoactive bowel sounds, which are soft and indicate decreased motility. Paralytic ileus, on the other hand, is a condition that can lead to hypoactive or absent bowel sounds.
Choice D Reason:
"Can be a result of a paralytic ileus" - Paralytic ileus typically results in hypoactive or absent bowel sounds, not hyperactive bowel sounds.
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