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A nurse is creating a plan of care for a newborn who is breastfed and appears jaundiced.

Which of the following interventions should the nurse include?

Place the newborn under a radiant warmer.

Supplement breastfeeding with iron-fortified formula.

Determine the effectiveness of breastfeeding.

Administer Rho(D) immune globin to the newborn.

Answer and Explanation

The Correct Answer is C

Choice A rationale:

Placing the newborn under a radiant warmer is not directly related to addressing breastfeeding-related jaundice.

Choice B rationale:

Supplementing breastfeeding with formula is not the first-line approach and may interfere with establishing successful breastfeeding.

Choice C rationale:

Breastfeeding-related jaundice can occur if the newborn is not effectively breastfeeding and not getting enough milk. Assessing the effectiveness of breastfeeding is important to address the underlying cause of jaundice.

Choice D rationale:

Administering Rho(D) immune globulin is unrelated to addressing jaundice in a breastfed newborn.

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Correct Answer is B

Explanation

Choice A rationale:

Padded wrist restraints are not appropriate unless there's a clear clinical indication to prevent self-harm or injury.

Choice B rationale:

After a seizure, it's important to establish IV access for the client to administer medications, fluids, or other interventions if needed. Monitoring for possible postictal state, airway patency, and vital signs are also important components of care.

Choice C rationale:

Administering lorazepam every 4 hours is not a standard protocol for post-seizure management and could lead to excessive sedation.

Choice D rationale:

Placing an incontinence brief is not necessary unless there's a specific indication, and it doesn't directly relate to post-seizure care.

A. Positive Rheumatoid factor B. WBC count 2.000/mm3 C. Hemoglobin 14.8 g/dL D. Erythrocyte sedimentation rate 24 mm/hr

Correct Answer is B

Explanation

Choice A rationale:

A positive Rheumatoid factor is associated with rheumatoid arthritis and is not an adverse effect of methotrexate.

Choice B rationale:

A low WBC count (leukopenia) is an adverse effect of methotrexate and can increase the risk of infection.

Choice C rationale:

A hemoglobin level of 14.8 g/dL is within a normal range and is not an adverse effect of methotrexate.

Choice D rationale:

An erythrocyte sedimentation rate (ESR) of 24 mm/hr is within a normal range and is not an adverse effect of methotrexate.

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A nurse is creating a plan of care for a newborn who is breastfed and appears jaundiced. Which of the following interventions should the nurse include?

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Naxlex Comprehensive Predictor Exams

A nurse is developing a plan of care for a client who has epilepsy and was admitted after experiencing a tonic-clonic seizure. Which of the following interventions should the nurse include in the plan?

Correct Answer is B

Explanation

A nurse is monitoring the laboratory values of a client who has rheumatoid arthritis and is taking methotrexate. Which of the following values should the nurse identify as an adverse effect of the medication?

Correct Answer is B

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A nurse is creating a plan of care for a newborn who is breastfed and appears jaundiced.

Which of the following interventions should the nurse include?