A nurse is caring for a newborn who had a circumcision 4 hr ago. During a diaper change, the nurse notes bright red blood oozing from the incision. Which of the following actions should the nurse take?
Place petroleum jelly on the bleeding site.
Secure a clean diaper snugly across the newborn's penis.
Rinse the newborn's penis with cool water.
Apply gentle pressure using a sterile dry gauze pad.
The Correct Answer is D
A. Petroleum jelly should be applied to prevent the diaper from sticking to the circumcision site, but it will not stop bleeding. Bright red blood oozing indicates that immediate action is needed to control bleeding.
B. Securing a clean diaper snugly could apply pressure but may not be the most effective method for controlling bleeding. It is more important to manage the bleeding directly by applying pressure.
C. Rinsing the newborn's penis with cool water is not an appropriate action for controlling bleeding. Cool water might be used for cleaning but does not address the issue of bleeding from the circumcision site.
D. Applying gentle pressure using a sterile dry gauze pad is the correct action to manage the bleeding. This method helps to control the bleeding by providing direct pressure to the site, which is crucial for addressing the issue.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
- Rationale for A: Aspirin is an antiplatelet agent and can increase the risk of bleeding, especially when combined with warfarin, an anticoagulant. Therefore, taking aspirin for leg discomfort is not recommended as it can exacerbate bleeding risks.
- Rationale for B: Oral contraceptives can interfere with the effectiveness of warfarin and increase the risk of thrombotic events. Women taking warfarin, especially in the postpartum period, should avoid oral contraceptives due to the potential for increased blood clotting.
- Rationale for C: The duration of warfarin therapy for deep-vein thrombosis is typically longer than 2 weeks. It is determined by the physician based on the extent of the clot and the patient's response to the medication.
- Rationale for D: Using a disposable razor can help minimize the risk of cuts and subsequent bleeding, which is a concern when taking anticoagulants like warfarin. It is a safer alternative to other shaving methods that may cause skin abrasions.
Correct Answer is B
Explanation
A. A client whose newborn is having difficulty latching-on should be addressed, but this issue is not an immediate postpartum emergency. It is important but does not require urgent intervention compared to potential complications from magnesium sulfate.
B. A client who received magnesium sulfate during labor should be seen first because magnesium sulfate can cause significant side effects like respiratory depression, decreased reflexes, and altered mental status. These effects require close monitoring to prevent severe complications.
C. A client who has a history of oligohydramnios requires monitoring but this history does not necessarily indicate an immediate postpartum issue requiring urgent assessment at this time.
D. A client whose labor lasted for 6 hr does not have an immediate concern solely based on labor duration. While it is relevant, it does not indicate an urgent need for assessment compared to the effects of magnesium sulfate.
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