The nurse is preparing a young couple and their 24-hour-old infant for discharge from the hospital. In conducting discharge teaching, which intervention is most important for the nurse to implement?

Request a return demonstration of a diaper change

Evaluate infant feeding techniques prior to discharge

Provide the results of the infant's hearing test to the parents.

Ensure that they have the pediatric clinic's phone number

Answer and Explanation

The Correct Answer is B

A. Request a return demonstration of a diaper change:While it's useful for parents to know how to change a diaper, feeding is more critical for the infant’s health and development in the early days.

B. Evaluate infant feeding techniques prior to discharge:Ensuring that the parents understand how to properly feed their newborn is crucial. Proper feeding techniques are essential for the infant's nutrition, growth, and development. Issues with feeding can lead to dehydration, weight loss, and other health problems. Therefore, this is the most important intervention.

C. Provide the results of the infant's hearing test to the parents:Sharing the results of the hearing test is important, but it is less immediate compared to ensuring that the infant is properly fed.

D. Ensure that they have the pediatric clinic's phone number:
While it is important for parents to have contact information for follow-up care, it is secondary to ensuring they can feed their baby properly.

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Correct Answer is B

Explanation

A. Insert a Foley catheter with a urimeter to monitor hourly output: This is a reasonable intervention because magnesium sulfate can affect renal function, and monitoring urinary output is essential. However, there's a more critical intervention to consider first.

B. Have calcium gluconate immediately available: This is the highest priority. Magnesium sulfate toxicity can lead to neuromuscular blockade, and calcium gluconate is the antidote. Having it readily available is crucial in case signs of magnesium toxicity (such as loss of deep tendon reflexes) appear.

C. Provide a quiet environment with subdued lighting: While maintaining a calm environment is generally important for clients on magnesium sulfate, it is not the highest priority in this situation.

D. Assess deep tendon reflexes (DTRs) every 4 hours: This is an important part of monitoring for magnesium sulfate toxicity. However, the immediate availability of calcium gluconate is the highest priority in case toxicity occurs.

A. Provide information about the high risk nature of her pregnancy B. Explain the benefits of a five-year post-transplant waiting period C. Gently remind the client that anti-rejection drugs cause sterility D. Determine if the client is considering options for adopting a child

Correct Answer is B

Explanation

A. Provide information about the high-risk nature of her pregnancy:

While it is true that pregnancies after organ transplantation are considered high-risk due to potential complications, the initial recommendation often involves waiting for a specified period.

B. Explain the benefits of a five-year post-transplant waiting period

After a liver transplant, healthcare providers typically recommend waiting for a certain period before attempting pregnancy. This waiting period allows the individual's health to stabilize, and it ensures that the transplanted organ is functioning optimally. Pregnancy, being a physiological stressor, can pose additional challenges to individuals with transplants. Waiting for a few years post-transplant is a precautionary measure to minimize potential risks.

C. Gently remind the client that anti-rejection drugs cause sterility:

This statement is not accurate. Anti-rejection drugs can affect fertility, but they do not cause sterility. The discussion should focus on the potential risks and safety considerations for pregnancy after a liver transplant.

D. Determine if the client is considering options for adopting a child:

While adoption might be an option, the primary intervention should involve discussing the waiting period and potential risks associated with pregnancy after a liver transplant.

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The nurse is preparing a young couple and their 24-hour-old infant for discharge from the hospital. In conducting discharge teaching, which intervention is most important for the nurse to implement?

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Naxlex Comprehensive Predictor Exams

The nurse is preparing to administer magnesium sulfate to a laboring client whose blood pressure has increased from 110/60 mmHg to 140/90 mmHg Which nursing protocol has the highest priority?

Correct Answer is B

Explanation

A young woman who underwent a liver transplant one year ago tells the clinic nurse that she would like to start a family. How should the nurse intervene?

Correct Answer is B

Explanation

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