Exhibits

A nurse is collecting data from a client who has pneumonia and a prescription for cefazolin. Which of the following findings should the nurse report to the provider prior to administering the initial dose? (Cliick on the exhibit tabs for additional information about t three tabs that contain separate categories of data.)

Temperature

WBC count

Allergies

Chest x-ray

Answer and Explanation

The Correct Answer is C

Rationale:

• Temperature: An elevated temperature of 39.3° C is consistent with an active infection like pneumonia. This finding supports the need for antibiotic treatment and does not delay administration unless linked to an adverse drug reaction.

• WBC count: A WBC count of 16,000/mm³ indicates leukocytosis, which is expected in bacterial pneumonia. It confirms infection and the need for antibiotics, not a reason to withhold cefazolin.

• Allergies: The client has a documented allergy to penicillin, which is critical because cefazolin is a cephalosporin. Cephalosporins share a similar beta-lactam structure and can cross-react in clients with penicillin allergies, increasing the risk of anaphylaxis. Reporting this ensures safe prescribing and prevents a life-threatening hypersensitivity reaction.

• Chest x-ray: The left lower lobe density confirms pneumonia. This imaging supports the clinical decision to administer antibiotics and does not warrant withholding the prescribed medication.

Nursing Test Bank

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Free Nursing Study Resources

Correct Answer is B

Explanation

Rationale:

A. "I should be able to follow my normal routine after the staples are removed from my incision.” Normal activities should be resumed gradually; simply removing staples does not mean the incision and abdominal muscles have fully healed.

B. "I will ask my partner to perform household chores until my incision is healed." Delegating strenuous tasks supports proper healing and prevents strain on the incision site, reflecting appropriate understanding of postpartum activity restrictions.

C. "I will wait 4 to 6 weeks to perform kegel exercises." Kegel exercises can usually begin soon after delivery to strengthen pelvic floor muscles and are not delayed for several weeks unless specifically advised.

D. "I will maintain modified bed rest for the first 48 to 72 hours at home." While initial rest is important, prolonged bed rest can increase the risk of complications like blood clots. Gradual ambulation is encouraged to promote circulation and recovery.

A. "Colostrum provides vitamin K which is an essential nutrient for newborns." B. "Colostrum provides many important antibodies that the newborn lacks." C. "Colostrum contains iron, which is important for a newborn's brain development." D. "Colostrum contains a natural diuretic that stimulates the newborn to void."

Correct Answer is B

Explanation

Rationale:

A. "Colostrum provides vitamin K which is an essential nutrient for newborns." While vitamin K is essential for clotting, it is not found in sufficient amounts in colostrum. This is why newborns routinely receive a vitamin K injection shortly after birth, rather than relying on breast milk as a source.

B. "Colostrum provides many important antibodies that the newborn lacks." Colostrum is rich in immunoglobulins, especially IgA, which help protect the newborn from pathogens by providing passive immunity. These antibodies line the infant's gastrointestinal tract and offer critical defense during early life.

C. "Colostrum contains iron, which is important for a newborn's brain development." Although breast milk contains iron, colostrum is not a major source of it. Newborns are typically born with adequate iron stores to last several months, and the primary role of colostrum is immune protection, not iron supplementation.

D. "Colostrum contains a natural diuretic that stimulates the newborn to void." While colostrum has a laxative effect that helps the newborn pass meconium, there is no known diuretic component. Its primary importance lies in delivering antibodies and coating the GI tract to reduce infection risk.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing discharge teaching about postpartum activity restrictions to a client who had a cesarean birth 2 days ago. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer is B

Explanation

A nurse is reinforcing teaching about colostrum with a new mother who is breastfeeding. The mother asks. "Why is colostrum so important for baby?" Which of the following responses should the nurse make?

Correct Answer is B

Explanation

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