During a daily assessment in the nursery, the practical nurse (PN) notices three large bluishblack areas on the back and buttocks of an African-American infant. Which action should the PN take?
A Write an incident report about the bruises on the infant.
B Review the labor and delivery record for birth trauma.
C Record the size and location of the areas in the infant's chart.
D Notify the pediatrician of a possible bleeding problem with the infant.
The Correct Answer is C
A. Write an incident report about the bruises on the infant. - These areas might not be bruises; hence, writing an incident report without accurate information could be premature.
B. Review the labor and delivery record for birth trauma. - While important, it might not directly relate to the observed bluish-black areas.
C. Record the size and location of the areas in the infant's chart. - Documenting the observations is essential for tracking changes and informing other healthcare providers.
D. Notify the pediatrician of a possible bleeding problem with the infant. - Without further assessment, assuming a bleeding problem might be premature and unnecessarily alarming.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["A","B","D","E"]
Explanation
A. Inserting the lubricated tip of the tubing 3 to 4 inches into the rectum allows for the proper administration of the enema.
B. Positioning the client in the left lateral recumbent position helps expose the rectum for the enema administration.
C. Chilling the enema solution isn't recommended as it might cause discomfort or shock to the client.
D. Encouraging the client to retain the solution for at least 5 minutes helps ensure effectiveness.
E. Clamping the enema administration tubing after filling the enema bag helps control the flow during the procedure.
Correct Answer is B
Explanation
A. Gravida (G) refers to the total number of pregnancies. This option counts all four pregnancies (twins, son, fetal loss) which is correct. Parity (P) refers to the number of pregnancies that have reached viable gestational age (20 weeks or beyond). Since the fetal loss at 24 weeks is included in the count, the parity is incorrectly stated as 4.
B. Gravida (G) counts all four pregnancies, which is accurate. Parity (P) considers only the pregnancies that reached viable gestational age. As there are two children from the twins, one child aged 4 years, and the fetal loss at 24 weeks (which is not considered as viable gestational age), the correct parity is 3.
C. Gravida (G) represented as 'S' typically indicates "stillbirths" rather than the total number of pregnancies. It does not provide an accurate representation of all pregnancies, so this is not the correct choice.
D. Gravida (G) counts five pregnancies, which doesn't accurately represent the scenario as there have been four pregnancies, not five. Parity (P) as 2 doesn't account for the twins, so it's incorrect.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.