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A new mother asks the nurse about an area of swelling on her baby's head near the posterior fontanel that lies across the suture line. How should the nurse respond?
A. "That is called caput succedaneum. It will have to be drained."
B. "That is called caput succedaneum. It will absorb and cause no problems."
C. "That is called a cephalhematoma. It will cause no problems."
D. "That is called a cephalhematoma. It can cause jaundice as it is absorbed."
B. "That is called caput succedaneum. It will absorb and cause no problems."
A client at 35 weeks gestation complains of a "pain whenever the baby moves". On assessment, the nurse notes the client's temperature to be 101.2F with severe abdominal or uterine tenderness on palpation. The nurse knows that these findings are indicative of which condition?
A. Round ligament strain.
B. Viral infection
C. Abruptio placenta
D. Chorioamnionitis
D. Chorioamnionitis
An unlicensed assistive personnel (UAP) reports to the charge nurse that a client who delivers a 7-pound infant 12 hours ago is reporting a severe headache. The client blood pressure is 110/70 mmHg, respiratory rate is 18 breaths/minute, heart rate is 74 bpm, and temperature is 98.6F. The client's fundus is firm and one fingerbreadth above the umbilicus. Which action should the charge nurse implement first?
A. Notify the healthcare provider of the assessment findings.
B. Obtain a STAT hemoglobin and hematocrit.
C. Assign a practical nurse (PN) to reassess the client's vital signs.
D. Determine if the client received anesthesia during delivery.
A. Notify the healthcare provider of the assessment findings.
The nurse is preparing to administer phytonadione to a newborn. Which statement made by the parents indicates understanding why the nurse is administering this medication?
A. Improve insufficient dietary intake.
B. Stimulate the immune system.
C. Prevent hemorrhagic disorders.
D. Help an immature liver.
C. Prevent hemorrhagic disorders.
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