A nurse is obtaining the temperature of a newborn. Which of the following sites should the nurse use?
Tympanic
Oral
Axillary
Rectal
The Correct Answer is C
A. Tympanic thermometers are not recommended for newborns because the ear canal is difficult to assess accurately in this age group.
B. Oral temperatures are not recommended for newborns due to the difficulty in ensuring accuracy.
C. The axillary site is the recommended method for obtaining a newborn's temperature. It is safe and non-invasive.
D. Rectal temperatures are accurate but are invasive and may cause discomfort or injury. It should only be used if other methods are not feasible.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. The client takes furosemide twice daily: There is no direct contraindication between furosemide and lavender oil.
B. Lavender oil, especially in aromatherapy, can trigger respiratory issues in some individuals, particularly those with asthma. Essential oils can act as irritants and exacerbate bronchospasms, potentially leading to wheezing, coughing, or an asthma attack. Therefore, the nurse should advise caution when using lavender oil in clients with a history of asthma.
C. The client takes vitamin C daily: There is no significant interaction between lavender oil and vitamin C.
D. While lavender has mild sedative properties, it is not a direct contraindication for clients with a history of alcohol use disorder. However, excessive use of lavender could enhance CNS depression when combined with alcohol, so it should be used with caution.
Correct Answer is D
Explanation
A. Monitor vital signs every hour for the first 4 hr: Incorrect. Vital signs should be monitored more frequently, typically every 15 minutes during the first hour after administration, due to the risk of bleeding.
B. Administer medications intramuscularly: Incorrect. Intramuscular injections should be avoided while the client is on alteplase due to the increased risk of bleeding.
C. Provide a diet low in protein: Incorrect. There is no need for a low-protein diet with alteplase therapy. The focus should be on managing bleeding risks and monitoring for complications.
D. Observe for bruising of the skin: Alteplase is a thrombolytic medication, and one of its major side effects is bleeding. The nurse should monitor the client for signs of bruising, bleeding, or hemorrhage.
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