Author Question: The student nurse attempts to take the vital sign of the newborn, but the newborn is crying. What ... (Read 86 times)

Davideckstein7

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The student nurse attempts to take the vital sign of the newborn, but the newborn is crying. What nursing action would be appropriate?
 
  1. Place a gloved finger in the newborn's mouth.
  2. Take the vital signs.
  3. Wait until the newborn stops crying.
  4. Place a hot water bottle in the isolette.

Question 2

The nurse receives a phone call from a 25-year-old woman experiencing breast tenderness in the week prior to her menses, with palpable breast nodularity, without nipple discharge. What is the best response by the nurse?
 
  1. Please make an appointment at the Breast Cancer center as soon as possible.
  2. How much salty food do you consume on a regular basis?
  3. As long as you don't have nipple discharge, it isn't a serious condition.
  4. Eliminate caffeine and chocolate from your diet.



kbennett34

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Answer to Question 1

1
Rationale:
1. To soothe a newborn during assessment or other procedures, place a gloved finger into the newborn's mouth.
2. Crying will increase heart rate and respiratory rate, so vitals should not be taken when the newborn is crying.
3. However, assessment of vitals needs to be done at regularly timed intervals, so waiting until the newborn stops crying might cause too long of a delay.
4. A hot water bottle should not be placed next to the newborn, because of a potential risk for burns.

Answer to Question 2

2
Rationale:
1. This is unnecessary, and might frighten the client. The client is describing fibrocystic breast changes.
2. The client is describing fibrocystic breast changes. A salt restriction with a mild diuretic taken the week before menstrual bleeding often improves the condition.
3. The client is describing fibrocystic breast changes, not a serious condition. The absence or presence of nipple discharge is not an indicator of seriousness of a breast condition.
4. The client is describing fibrocystic breast changes. Research is inconclusive as to whether eliminating methylxanthines from the diet is effective at reducing fibrocystic breast symptoms.



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