ACTUAL NR327 EXAM 2 TE ST

ACTUAL NR327 EXAM 2 TE ST –

ACTUAL TEST WITH CORREC T ANSWERS

GRADED A+

A nurse is caring for a newborn immediately following a circumcision using a Gomco procedure. Which of the following actions should the nurse implement?

• Apply Gelfoam powder to the site
• Place the newborn in the prone position
• Apply petroleum gauze to the site
• Avoid changing the diaper until the first voiding

Answer: C

Petroleum gauze is applied to the site for 24 hours to prevent the skin edges from sticking to the diaper.The diaper is changed more frequently to inspect the site.Gelfoam powder is only applied to control bleeding when there is a risk for hemorrhage. The baby should not be put in the prone position A nurse is reviewing car seat safety with the parents of a newborn. Which of the following instructions should the nurse include in the teaching regarding car seat position?

• Front seat, rear-facing
• Front seat, forward-facing
• Back seat, rear-facing 1 / 4

• Back seat, forward-facing

Answer: C

This position should be maintained until the child is at least 2 years of age A nurse is caring for a client who is at 42 weeks gestation and in labor. The client asks the nurse what to expect because the baby is postmature. Which of the following statements should the nurse make?

• "Your baby will have excess body fat"
• "Your baby will have flat areola without breast buds"
• "Your baby's heels will easily move to his ears"
• "Your baby's skin will have a leathery appearance"

Answer: D

This finding is due to placental insufficiency.Heals that are moveable fully to the ears and flat areolas without breast buds are seen in a newborn who is preterm.Excess body fat is seen in a newborn who is macrosomic.A nurse is caring for an infant who has a high bilirubin level and is receiving phototherapy. Which of the following is the priority finding in the newborn?

• Conjunctivitis
• Bronze skin discoloration
• Sunken fontanels
• Maculopapular skin rash 2 / 4

Answer: C

The infant is at risk for dehydration from loose stools due to increased bilirubin excretion from the phototherapy A nurse is called to the birthing room to assist with the assessment of a newborn who was born at 32 weeks gestation. The newborn's birth weight is 1,100 g. Which of the following are expected findings in this newborn? (SATA)

• Lanugo
• Long nails
• Weak grasp reflex
• Translucent skin
• Plump face

Answer: A, C, D

A plump face would be observed in an infant who is macrosomic.Long nails are a finding in a newborn who is postmature A nurse is caring for a newborn who is preterm and has respiratory distress syndrome. Which of the following should the nurse monitor to evaluate the newborn's condition following administration of synthetic surfactant?

• Oxygen saturation
• Body temperature
• Serum bilirubin
• Heart rate 3 / 4

Answer: A

Surfactant stabilizes the alveoli and helps increase oxygen saturation.A nurse is teaching a newly licensed nurse about neonatal abstinence syndrome. Which of the following statements by the newly licensed nurse indicate understanding of the teaching?

• "The newborn will have decreased muscle tone"
• "The newborn will have a continuous high-pitched cry"
• "The newborn will sleep for 2 to 3 hours after a feeding"
• "The newborn will have mild tremors when disturbed"

Answer: B

This is often an indication of CNS disturbances in a newborn with neonatal abstinence syndrome.INCREASED muscle tone, sleep pattern disturbances that cause difficulty with sleeping for 2-3 hours after feeding, and MODERATE/SEVERE tremors when undisturbed.A nurse is providing teaching to a client who is postpartum and does not plan to breastfeed her newborn. Which of the following instructions should the nurse include in the teaching?

• Stand under a hot shower with your breasts exposed
• Place ice packs on your breasts
• Wear a loose-fitting, comfortable bra
• Limit fluid intake to 1L per day
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