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Supplementing breastfeedings with water every 12 hours is not advised for newborns, as breast milk provides complete hydration and nutrition. Water can reduce milk intake, decreasing supply due to reduced demand. It risks electrolyte imbalances, like hyponatremia, in infants with immature kidneys. Exclusive breastfeeding for six months supports optimal growth, immune function, and maternal-infant bonding, making this recommendation inappropriate.

Limiting feeding to 10 minutes per breast can prevent adequate hindmilk transfer, which is high in fat and calories, essential for growth. Short sessions may reduce milk supply due to insufficient stimulation. Infants need variable feeding times to meet nutritional needs. This restriction risks poor weight gain and inadequate nutrition, indicating it’s not a suitable recommendation.

Starting each feeding with the same breast can cause imbalanced milk production, as one breast may be understimulated, reducing overall supply. Alternating breasts ensures both are drained, supporting balanced lactation and preventing engorgement or mastitis. This practice maintains milk supply via prolactin release, making this advice incorrect for optimal breastfeeding.

Vomiting is not a typical amniocentesis complication. The procedure is localized to the uterus, with minimal systemic effects. Nausea may occur from anxiety, but vomiting is rare and not a priority for monitoring. Focus remains on uterine and fetal complications, like contractions or fluid leakage, which directly impact pregnancy safety and outcomes.

Hypertension is not directly linked to amniocentesis. The procedure does not typically affect maternal cardiovascular function, as it’s a localized intervention. Monitoring for hypertension is more relevant for conditions like preeclampsia. Post-amniocentesis, the priority is uterine activity and fetal distress, not blood pressure, making this an irrelevant complication to monitor.

Polyuria is not associated with amniocentesis, as the procedure does not impact renal function or fluid balance. The focus is on complications like contractions, bleeding, or amniotic fluid leakage, which pose direct risks to the pregnancy. Monitoring polyuria is unnecessary, as it does not reflect the procedure’s physiological effects or risks.

Comparing the medication label to the provider’s prescription three times is a safety step during administration, not reconciliation. Reconciliation verifies the client’s home medications against new orders to prevent errors like omissions or duplications. This action occurs post-reconciliation, focusing on administration accuracy, not the initial verification of the medication list.

Administering medications to treat a condition to the actual prescriptions is unclear and not part of reconciliation. Reconciliation focuses on verifying and documenting medications, not administering them. This option does not align with the systematic process of ensuring all medications are correctly prescribed upon admission, making it incorrect.

Ensuring administration within 3 hours of the scheduled time relates to medication administration protocols, not reconciliation. Reconciliation verifies the accuracy of the medication list before administration. This step is about timing, not the verification process critical to preventing errors during care transitions, rendering it irrelevant to the task.

A single light fixture along the sidewalk provides limited illumination, insufficient for comprehensive safety. Multiple, evenly spaced lights are needed to prevent falls, especially for older adults. Inadequate lighting increases risks of trips or assaults, indicating the client’s understanding of outdoor safety is incomplete and does not fully address home safety needs.

A small area rug at the front door poses a tripping hazard, particularly for those with mobility issues. Loose rugs can lead to falls, causing injuries like fractures. This finding suggests the client does not fully understand fall prevention, a key aspect of home safety, making it an incorrect indicator of safety awareness.

Securing electrical cords under furniture risks fire hazards if cords are damaged or pinched, potentially causing electrical shorts. Cords should be secured along walls or with covers to prevent tripping without compromising safety. This indicates a misunderstanding of electrical safety, increasing fire or injury risks, and is not a correct safety measure.

Routine health screenings are part of secondary prevention, focusing on early detection of diseases before symptoms appear. Tertiary prevention addresses management after diagnosis, so this action is misaligned with the phase, making it incorrect for the workshop content.

Administering vaccinations is primary prevention, aimed at preventing diseases before they occur. Tertiary prevention involves managing existing conditions, so vaccinations do not fit this phase, making this an incorrect choice for interprofessional care focus.

Educating about healthy lifestyles is primary prevention, promoting health to prevent disease onset. Tertiary prevention focuses on managing established conditions, so this action is incorrect for the tertiary phase in interprofessional collaboration.

Asking for more information about the surgery indicates the client seeks clarification but does not confirm understanding of informed consent. Informed consent requires comprehension of the procedure, risks, benefits, and alternatives, with agreement to proceed. This statement reflects curiosity, not confirmation of understanding, making it insufficient to demonstrate informed consent.

Planning to ask the doctor about the surgery in the operating room suggests the client has not yet received or understood the necessary information. Informed consent must be obtained before entering the operating room, with full comprehension of risks and benefits. This statement indicates a lack of prior understanding, making it incorrect.

Having family sign the consent form is inappropriate unless the client lacks decision-making capacity, which is not indicated. Informed consent requires the competent client’s understanding and agreement. This statement suggests reliance on others, not personal comprehension of the procedure’s risks and benefits, making it an incorrect indicator of understanding.

Occasional mild nausea is common in early pregnancy due to hormonal changes and does not typically require reporting unless severe or persistent. It is not a concerning finding at 14 weeks, so this is incorrect for urgent reporting.

Mild ankle swelling in the evening can be normal due to fluid retention but is not urgent unless accompanied by other preeclampsia signs. It is less critical than bleeding, so this is incorrect for priority reporting.

Increased appetite is normal in pregnancy as nutritional needs rise and does not warrant urgent reporting. It reflects healthy adaptation rather than a complication, so this is incorrect for inclusion in teaching about concerning findings.

A puncture wound to the lung is life-threatening, potentially causing pneumothorax or hemothorax, requiring urgent intervention (red tag). This is not a minor injury, so it does not qualify for a green tag, making it incorrect.

Full-thickness burns over the lower extremities are severe, requiring immediate fluid resuscitation and specialized care (red or yellow tag). These are not minor injuries, so this client does not fit green tag criteria, making it incorrect.

An open compound fracture of the humerus is a significant injury with risks of infection and bleeding, requiring prompt surgical intervention (yellow or red tag). It is not minor, so it does not qualify for a green tag, making it incorrect.

Preventing leakage is not the primary purpose of flushing an intermittent infusion device. Flushing maintains patency by clearing blood or medication residue, preventing clots or blockages. Leakage is addressed by proper capping or clamping, not flushing, making this statement incorrect as it misrepresents the procedure’s purpose.

Flushing an infusion device does not contribute to hydration, as the flush solution (typically saline) is minimal and not intended for fluid replacement. The purpose is to maintain catheter patency by clearing debris or clots. This statement is incorrect, as it inaccurately suggests a hydration benefit unrelated to the procedure.

Flushing does not ensure sterility, as the device is already in place and exposed to the bloodstream. Sterility is maintained during insertion or access, not flushing. The primary goal is patency, not sterilization, making this statement incorrect as it misaligns with the procedure’s clinical purpose.

Changing the stoma pouch 30 minutes after meals is not recommended, as meal timing does not dictate pouch changes. Pouches are typically changed every 3-7 days or if leaking, to prevent skin irritation. This statement reflects a misunderstanding, as it suggests an incorrect schedule unrelated to stoma care needs.

Cleaning the stoma with moisturizing soap is incorrect, as soaps with oils or fragrances can irritate peristomal skin and impair pouch adhesion. Mild, non-residue soap and water are recommended to maintain skin integrity. This statement indicates a misunderstanding of proper stoma cleaning practices.

Expecting the stoma to be blistered is incorrect, as a healthy stoma should be pink, moist, and free of irritation. Blistering indicates complications like infection or poor pouch fit. This statement reflects a misunderstanding of normal stoma appearance and care, suggesting potential issues requiring intervention.

Decreasing fluid intake to firm stools is incorrect, as adequate hydration (2-3 L/day) is essential to prevent constipation, especially with opioids like oxycodone, which slow intestinal motility. Low fluid intake hardens stools, exacerbating constipation risk by reducing water content in the colon, indicating a misunderstanding of prevention strategies.

Taking a laxative only when constipated is reactive, not preventive. Opioids like oxycodone commonly cause constipation by reducing peristalsis via mu-opioid receptors in the gut. Prophylactic use of stool softeners or laxatives is recommended to maintain regular bowel movements, making this statement incorrect as it lacks a preventive approach.

Exercising less to conserve energy worsens constipation, as physical activity stimulates intestinal motility, countering opioid-induced slowing. Regular movement, like walking, promotes bowel function by enhancing peristalsis and blood flow to the gut. This statement indicates a misunderstanding, as reduced activity increases constipation risk.

Checking the medication label twice is part of the “rights” of administration but is less specific than using two identifiers for client verification. While important, it addresses medication accuracy, not client identity, which is the primary safety concern to prevent errors, making it less critical in this context.

Administering medication within 3 hours of the scheduled time relates to timing protocols, not the core action of ensuring safe administration. While timely administration is important, verifying client identity is the priority to prevent errors, as incorrect patient identification can lead to severe adverse events, making this less relevant.

Administering medications to treat a condition to the actual prescriptions is vague and not a standard safety action. The focus is on verifying client identity and medication accuracy, not a general treatment alignment. This statement does not address a specific, actionable step in safe medication administration, making it incorrect.

Asking another nurse to assist is insufficient for a 136 kg client unable to help, as manual lifting risks injury to staff and client. Mechanical lifts are required for heavy or non-assistive clients to ensure safety, making this option inadequate and unsafe for the transfer scenario described.

Positioning the client upright before transfer is impractical for a non-assistive client weighing 136 kg, as it requires significant manual effort and risks injury. Mechanical lifts are needed to safely move such clients, ensuring stability and preventing falls, making this action inappropriate for the transfer.

A sliding board is unsuitable for a 136 kg client unable to assist, as it requires some patient cooperation and strength. It risks injury to staff and client due to the client’s weight and inability to participate. Mechanical lifts are the safer, recommended method for this transfer.

Using a donut-shaped cushion is not recommended, as it can increase pressure on surrounding tissues, worsening ischemia in the ischial area. Nonblanchable erythema indicates early pressure injury, requiring pressure relief and skin protection. This intervention risks further tissue damage, making it inappropriate for managing the client’s condition.

Repositioning every 15 minutes while sitting is excessive and impractical, potentially causing discomfort or skin shear. For paraplegic clients, repositioning every 1-2 hours while sitting, combined with pressure-relieving cushions, prevents progression of nonblanchable erythema. This frequency is not evidence-based for pressure injury prevention, making it incorrect.

Repositioning every 3 hours in bed is insufficient for a paraplegic client with nonblanchable erythema, as guidelines recommend every 2 hours to relieve pressure. Prolonged pressure risks advancing tissue damage, especially in high-risk areas like the ischium. This intervention is inadequate for preventing pressure injury progression.

A pain level of 1 on a 0-10 scale indicates well-controlled pain, which does not directly impair wound healing. Adequate pain management supports mobility and recovery, reducing stress responses that could delay healing. This finding is not a risk factor for delayed wound healing in post-surgical clients.

An oxygen saturation of 92% on room air is slightly low but not critically hypoxic. Wound healing requires adequate oxygenation, but levels above 90% are generally sufficient for tissue repair. This finding alone does not significantly indicate a risk for delayed wound healing compared to nutritional deficits.

A body mass index of 22 is within the normal range (18.5-24.9) and does not indicate malnutrition or obesity, both of which can impair wound healing. Normal BMI supports adequate nutritional status for tissue repair, making this finding not a risk factor for delayed wound healing.

Marking drainage output every 48 hours is too infrequent to accurately assess drainage in a closed wound drainage system. Frequent monitoring (e.g., every shift) is needed to track output, detect complications like excessive bleeding, and ensure system functionality, making this intervention inadequate for assessment.

Stripping the chest tube vigorously is not recommended, as it can increase intrathoracic pressure, risking tissue damage or bleeding. It does not assess drainage amount but manipulates the tube, potentially causing harm. Assessment requires observing output in the collection chamber, making this action incorrect.

Adding water to the water seal chamber maintains system function but does not directly assess drainage amount. The water seal prevents air re-entry, not measures output. Assessment involves observing and recording drainage in the collection chamber, making this action irrelevant to the question’s focus.

Assuring the client about future pregnancies dismisses her current emotional loss, potentially invalidating grief. Stillbirth triggers complex hormonal and psychological responses, including postpartum depression risk. This approach fails to address immediate emotional needs, hindering the grieving process and emotional recovery in perinatal loss.

Avoiding discussion of the newborn ignores the client’s need to process her loss. Acknowledging the baby’s existence is critical for healthy mourning, as psychological research shows verbalizing grief aids emotional integration. Silence may suppress coping, prolonging unresolved grief and complicating psychological adjustment post-stillbirth.

Discouraging friends from seeing the newborn dismisses the client’s need for social support. Communal acknowledgment of loss mitigates isolation, a key factor in grief recovery. This action disrupts psychological coping by limiting social validation, potentially exacerbating feelings of loneliness and hindering emotional healing after stillbirth.

Referring to a mental health clinic addresses potential emotional distress but not the adolescent’s primary concern of affordability. Pregnancy increases psychological stress, but financial barriers to prenatal care are critical. This action fails to ensure access to medical resources, essential for maternal and fetal health in adolescent pregnancy.

Contacting the adolescent’s parent risks breaching confidentiality, depending on legal guidelines, and does not address financial concerns directly. Family dynamics may complicate support, and without consent, this action could increase stress, failing to provide immediate healthcare access critical for a healthy pregnancy outcome.

Advising adoption is premature and overlooks the adolescent’s autonomy. Adoption requires extensive counseling, not immediate recommendation. It fails to address healthcare access, critical for a healthy pregnancy. This approach dismisses financial solutions, potentially increasing stress and undermining informed decision-making in pregnancy.