PN Comprehensive Online Practice 2023 B

A nurse is reinforcing teaching with a client who has tuberculosis and a new prescription for rifampin. Which of the following statements by the client indicates an understanding of the teaching?

"I will use condoms in addition to birth control pills to decrease my risk of becoming pregnant." Rifampin can interact with and reduce the effectiveness of oral contraceptives. Therefore, the nurse should instruct the client to use a secondary method to prevent pregnancy.

A nurse is reinforcing teaching with a client who has hypothyroidism and a prescription for levothyroxine. Which of the following instructions should the nurse include in the teaching?

"You will need to take the medication for the rest of your life." Hypothyroidism is a chronic disorder that requires lifelong thyroid hormone replacement therapy.

A nurse is collecting data on a newborn who is 3 days old. Exhibit 1 History and Physical Newborn was delivered at 37 weeks gestation via cesarean section for fetal distress.Apgar scores 8 at 1 min and 9 at 5 min.Birthweight 2,892 g (6 lb 6 oz)The client who gave birth plans to breastfeed. Exhibit 2 Flow Sheet Day 2 of Life 0900: Temperature 36.7° C (98° F)Heart rate 140/minRespiratory rate 48/minWeight 2,718 g (6 lb), 6% weight lossDay 3 of Life 0800:​ Temperature 36.4° C (97.5° F)Heart rate 140/minRespiratory rate 48/minWeight 2,545 g (5 lb 9 oz), 12% weight loss Exhibit 3 Nurses' Notes Day 3 of Life 0800: Skin color consistent with newborn's genetic background. Respirations easy and unlabored. Abdomen soft with active bowel sounds. Mild tremors noted when awake. Anterior fontanel level and soft. Large ecchymotic caput succedaneum noted on posterior scalp. Small amount of bloody mucus discharge noted from vag

Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again. Temperature 36.4° C (97.5° F) Weight 2,545 g (5 lb 9 oz) 12% weight loss Mild tremors noted when awake. Breastfeeding every 3 to 5 hr for 5 to 10 min. Birth parent reports nipple discomfort throughout the feeding. When recognizing cues, the nurse should identify that a temperature of 36.4° C (97.5° F) is below the expected reference range. Hypothermia can lead to the occurrence of hypoglycemia and respiratory distress. The newborn breastfeeding for short intervals, nipple discomfort, and a weight loss of greater than 10% of birth weight can indicate inadequate transfer of breastmilk, which can result in hypoglycemia. The presence of mild tremors can be a manifestation of hypoglycemia.

A nurse is assisting with the care of a client who has schizophrenia in an inpatient facility. Exhibit 1 Medication Administration Record Day 1 0630: Clozapine 100 mg PO dailyAripiprazole 5 mg PO dailyMultivitamin PO daily Exhibit 2 Laboratory Results Day 1 0630: Sodium 125 mEq/L (136 to 145 mEq/L) Potassium 3.5 mEq/L (3.5 to 5 mEq/L) Chloride 90 mEq/L (98 to 106 mEq/L) BUN 8 mg/dL (10 to 20 mg/dL) Magnesium 1.2 mEq/L (1.3 to 2.1 mEq/L) Total calcium 10 mg/dL (9 to 10.5 mg/dL) Phosphate 4 mg/dL (3 to 4.5 mg/dL) Glucose 70 mg/dL (74 to 106 mg/dL) Exhibit 3 Vital Signs Day 1 0630: Temperature 37.6° C (99.6° F)Heart rate 102/minRespiratory rate 24/minBlood pressure 140/90 mm HgOxygen saturation 98% on room air 1230: Temperature 37.6° C (98° F)Heart rate 98/minRespiratory rate 20/minBlood pressure 142/92 mm HgOxygen saturation 100% on room air 1730: Temperature 37.1° C (98.8° F)Heart rate 104/minRespiratory rate 24

Click to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again. When analyzing cues, the nurse should identify that the client is taking a second-generation antipsychotic medication, which can lead to manifestations of tardive dyskinesia, including involuntary tongue movement and foot tremors. Frequent urination and incontinence are adverse effects of aripiprazole and should be reported to the provider. An increase in agitation is a safety risk for the client, staff, and others on the unit and requires immediate de-escalation.

A nurse is assisting with the care of a client who has a new diagnosis of anorexia nervosa. Exhibit 1 Laboratory Results Day 1 2030: Sodium 146 mEq/L (136 to 145 mEq/L) Potassium 3.3 mEq/L (3.5 to 5 mEq/L) Chloride 110 mEq/L (98 to 106 mEq/L) BUN 21 mg/dL (10 to 20 mg/dL) Magnesium 1.2 mEq/L (1.3 to 2.1 mEq/L) Phosphate 2.8 mg/dL (3 to 4.5 mg/dL) Glucose (casual) 75 mg/dL (74 to 106 mg/dL) Total protein 5.8 g/dL (6.4 to 8.3 g/dL) Albumin 3 g/dL (3.5 to 5 g/dL)Day 2 0530: Sodium 150 mEq/L (136 to 145 mEq/L) Potassium 3.1 mEq/L (3.5 to 5 mEq/L) Chloride 110 mEq/L (98 to 106 mEq/L) BUN 25 mg/dL (10 to 20 mg/dL) Magnesium 1 mEq/L (1.3 to 2.1 mEq/L) Phosphate 2.8 mg/dL (3 to 4.5 mg/dL) Fasting blood glucose 65 mg/dL (74 to 106 mg/dL) Total protein 5.5 g/dL (6.4 to 8.3 g/dL) Albumin 2.7 g/dL (3.5 to 5 g/dL) Exhibit 2 Nurses' Notes Day 1 2005: Client alert and oriented with flat affect. Client states, "I cannot gain any mor

Complete the following sentence by using the lists of options. The nurse should first address the client's electrolyte imbalance , followed by the client's fear of weight gain When analyzing cues, the nurse should first address the client's electrolyte imbalance. The client has hypokalemia, which increases the risk for cardiac arrhythmias. Once the client's medical concerns are addressed, the nurse should then focus on the underlying psychological issues behind the eating disorder, such as the client's fear of weight gain.

A nurse is assisting with the care of a client admitted with profuse vomiting and abdominal pain. Exhibit 1 Nurses' Notes 0700: Client reports abdominal pain as 8 on a scale of 0 to 10 for 4 days. Nausea and profuse vomiting for 3 days. Client reports last bowel movement was 5 days ago.Abdominal: upper epigastric distension noted. Bowel sounds absent. Abdominal tenderness and rigidity noted on palpation. Abdominal distension noted.Allergies: penicillin, meperidine0800: Client reports worsening pain of 10 on a scale of 0 to 10 in midabdominal area. NG tube placed and verified by x-ray. Client tolerated procedure.0915: Client continues to report pain level of 10 on a 0 to 10 scale. NG tube output 400 mL. Exhibit 2 Laboratory Results 0730: Sodium 136 mEq/L (136 to 145 mEq/L) Potassium 3.6 mEq/L (3.5 to 5 mEq/L) Chloride 110 mEq/L (98 to 106 mEq/L) BUN 24 mg/dL (10 to 20 mg/dL) Magnesium 1.4 mEq/L (1.3 to 2.1 mEq/L) Tota

Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is at risk for developing anaphylactic reaction due to bowel obstruction Upon recognizing client cues, the nurse should identify the client's WBC level, temperature, and neutrophils are outside the expected reference range, which can indicate an infection as a result of a bowel obstruction. A bowel obstruction can occur for a variety of reasons, including constipation, bowel adhesions, and medication adverse effects. The other areas of concern have been addressed with pain medication and IV fluids. The nurse should anticipate continuation of medical interventions.

A nurse is assisting with the care of a client who has bulimia nervosa. Exhibit 1 Admission Assessment Day 1 0630: Client admitted to inpatient unit for evaluation and treatment following report of binge eating and vomiting for more than 1 year.Client reports feeling excessively tired and light-headed.Neurologic: Client alert and oriented x 3.Respiratory: Lungs clear and equal bilaterallyHeart rate 65/minGastrointestinal: Diminished bowel sounds noted x 4. Client reports vomiting three to four times per day.Weight 67 kg (127 lb)Height 165.1 cm (65 in)Integumentary: Small superficial lacerations and calluses noted on fingers bilaterally. Breakdown noted around edges of lips Exhibit 2 Laboratory Results Day 1 0730: Sodium 134 mEq/L (136 to 145 mEq/L)Potassium 3.4 mEq/L (3.5 to 5 mEq/L)Chloride 97 mEq/L (98 to 106 mEq/L)Total calcium 10 mg/dL (9 to 10.5 mg/dL)Glucose 74 mg/dL (74 to 106 mg/dL)Day 2 0730: Sodium 132 mEq/

Drag words from the choices below to fill in each blank in the following sentence. The client is at risk for developing cardiovascular abnormalities and electrolyte imbalance When recognizing cues, the nurse should determine that the client is at the greatest risk of developing cardiovascular abnormalities and electrolyte imbalance due to chronic vomiting. When chronic vomiting occurs, abnormal electrolytes result in hypokalemia, hypochloremia, and hyponatremia. Cardiovascular abnormalities such as bradycardia, arrhythmias, and electrocardiograph changes can occur.

A nurse on a mental health unit is caring for a client. Exhibit 1 Nurses' Notes Day 1: Client admitted due to manifestations of depression, feelings of guilt, and thoughts of self-harm.The client reports not sleeping well and feeling irritable. Flat affect noted. Client also reports poor appetite and difficulty concentrating.Day 2: Client slept for 4 hr the previous night, ate 25% of breakfast. Client did not participate in group therapy and spent most of the day in their room yesterday. Exhibit 2 Provider Prescriptions Citalopram 20 mg PO daily

For each nursing action, click to specify if the nursing action is anticipated or contraindicated for the client. While taking action for this client, the nurse should identify that initiating suicide precautions, encouraging the client to attend group therapy, and frequently offering high calorie snacks are anticipated. The client expresses feelings of guilt, exhibits a flat affect, and expresses thoughts of self-harm, which increase the risk for suicidal behavior. The client should be encouraged to attend individual and group therapy to promote participation in the treatment plan. Frequent high calorie and high protein snacks can increase the client's intake and might be better tolerated than larger meals. The nurse should identify that allowing the client to sleep with their hands out of view is contraindicated due to the risk of self-harm.

A nurse is assisting with the care of a client who was admitted to the emergency department (ED). Exhibit 1 Admission Assessment Day 1 1930: Client admitted to the ED by police after report of violent behavior in public. Client smashed a glass window with their hands. Client is stating, "I am Jesus." Client is attempting to hit staff. Client placed in restraints. Neuro: Client is alert and oriented x 0. Client is swinging their arms and shouting. Client is unable to answer questions and their speech is rapid and unorganized. Heart rate is 108/min, regularIntegumentary: Laceration noted to the client's left hand (2 cm x 2.5 cm). Laceration noted to the left forearm (4 cm x 6 cm). Profuse bleeding noted. Multiple small lacerations noted to face, left arm, and right arm. Allergies: Unable to assess Exhibit 2 Vital Signs Day 1 1930: Temperature 36.7° C (98.0° F)Pulse 108/minRespiratory rate 24/minBP 150/92 mm Hg1945: P

For each potential assessment finding, click to specify if the finding is consistent with schizophrenia or bipolar 1 disorder. Each finding may support more than 1 disease process. When analyzing cues, the nurse should distinguish between positive and negative manifestations of schizophrenia and bipolar 1 disorder. The client is displaying positive manifestations of schizophrenia, when compared to the assessment findings of a client who has bipolar 1 disorder.

A nurse is caring for a client who is postoperative following a perineal prostatectomy. Exhibit 1 Nurses' Notes Postoperative Day 1 0900: Client reports pain at the perineal surgical incision site as 5 on a scale of 0 to 10. Client reports bladder fullness. Perineal dressing intact with minimal serosanguinous drainage.Client reports hard, painful bowel movement.Client transferring out of bed to chair independently.Postoperative Day 2 1300: Client reports abdominal cramping and small, hard, painful bowel movement after lunch. Ambulating independently in hallway. Reports pain in perineum as 8 on a scale of 0 to 10.Indwelling urinary catheter draining pink-tinged urine. Exhibit 2 I&O Postoperative Day 1 0600 to 1400: Urine output 1,200 mLTotal fluid intake 1,500 mL

For each potential postoperative complication below, click to specify the nursing intervention that the nurse should implement. When taking actions for a client who is postoperative following a perineal prostatectomy, the nurse should assist the client with a sitz bath, encourage the client to drink prune juice, and instruct the client to perform calf pump and foot circle exercises. The nurse should offer the client a sitz bath to relieve pain and promote healing. The nurse should encourage the client to drink prune juice to relieve constipation. The nurse should instruct the client to perform calf pump and foot circle exercises to promote venous return and reduce the risk of a deep vein thrombosis.

A nurse is assisting with the care of a client following a total hip replacement. Exhibit 1 Provider Prescriptions Postoperative Day 3 1400: Enoxaparin 30 mg subcutaneous every 12 hrMorphine 4 mg IV bolus every 3 to 4 hr for painOndansetron 4 mg PO as needed for nauseaAcetaminophen 500 mg PO every 4 to 6 hr for temperature greater than 38.4° C (101.1° F) Exhibit 2 Nurses' Notes Postoperative Day 3 1500: RN administered morphine for pain rating of 8 on a scale of 0 to 10. 1600: Client rates pain as a 5 on a scale of 0 to 10. Pain medication effective. Exhibit 3 Assessment Postoperative Day 3 1400: Alert and oriented to person, place, and time. Skin warm and dry. Lungs clear, auscultated throughout all lung fields. Regular heart rhythm.No nausea or vomiting noted, bowel sounds present in all four quadrants. Last bowel movement 1 day ago.Peripheral pulses strong 2+ bilaterally, capillary refill 4 seconds.Voided 200 mL

For which of the following assessment findings should the nurse notify the provider? Select all that apply. When analyzing cues, the nurse should identify that a partial-thickness pressure injury over the sacral area, aching/cramping in the left calf, and a capillary refill of 4 seconds are unexpected findings 3 days postoperative for a total left hip replacement and can indicate complications of immobility, such as skin breakdown and deep vein thrombosis. These findings should be reported to the provider.

A nurse is assisting in the care of a client who is 1 hr postpartum. Exhibit 1 Nurses' Notes 1200: Large amount of lochia rubra noted on perineal pad. Fundus boggy at two fingerbreadths above the umbilicus. Oxytocin 20 units being administered via continuous IV infusion 1215: Large amount of lochia rubra with several large clots noted. Client reports feeling anxious. Skin cool and clammy. Provider notified. Exhibit 2 Vital Signs 1200: Temperature 37.5° C (99.5° F)Heart rate 92/minRespiratory rate 22/minBP 100/60 mm HgSaO2 97% on room air1215: Temperature 37.1° C (98.8° F)Heart rate 112/minRespiratory rate 26/minBP 90/52 mm HgSaO2 92% on room air

Select the 6 actions the nurse should take. Provide emotional support. Administer methylergonovine. Weigh the perineal pads. Insert an indwelling urinary catheter. Administer oxygen at 12 L/min via nonrebreather face mask. Firmly massage the uterine fundus.

A nurse is caring for a client in an inpatient mental health facility. Exhibit 1 Medical HistoryClient is 44 years old, well-nourished, presenting with recurrence of labile behavior involving self-mutilation, recent arrest for reckless driving, stealing money from work for gambling debts, depressive episodes, and binge eating.Provider's skin assessment reveals multiple superficial self-inflicted lacerations to right arm. Client plays golf three mornings per week. Employed as salesperson at a car dealership for 8 years. Exhibit 2 Nurses' Notes Day 1 1500: Client is talkative, well-groomed. Expresses anxiety when left alone and states they would prefer a roommate. The client tends to be the center of attention in the dayroom. 1600: Client assigned a roommate.Day 2 1300: Pacing for last hour and mumbling to self. Argued with staff earlier about going to lunch in the cafeteria. Glaring at staff members with fists clenche

Select the 2 findings from the client's medical record that are manifestations of borderline personality disorder. Behavior toward roommate Skin assessment When recognizing cues, the nurse should identify that the client's skin assessment and behavior toward roommate are indications of borderline personality disorder. Clients who have borderline personality disorder display unstable relationships, labile moods, and impulsivity, such as excessive spending, binging, substance abuse, and reckless driving. They also have recurrent episodes of self-harm and might engage in suicidal actions. They have difficulty controlling their anger and might have paranoid ideations. They have chronic feelings of emptiness and do not like to be alone.

A nurse is assisting with the care of a client in the emergency department (ED). Exhibit 1 Nurses' Notes 0600: Client presents with acute altered mental status. Client has a history of frequent ED visits for alcohol intoxication. Client states that they had an episode of binge drinking yesterday afternoon. Client awoke this morning on the living room floor trembling and flushed; remembers having intense dreams and was afraid they had a seizure so called a family member to bring them to the ED.The client reports their average alcohol intake has been "two or three beers" after work each day and "more on the weekends" for the past 6 months.Client reports headache, nausea, agitation, and is noted to be diaphoretic.0800: "I've got bugs crawling on me. Get them off me!" Client tremulous and diaphoretic. Exhibit 2 History and Physical Alcohol use disorderDelirium tremensNicotine use disorder, 20-year pack historyHypertensio

The nurse is contributing to the plan of care for the client. Select the 5 actions the nurse should implement. When generating solutions or planning care for a client who is experiencing alcohol withdrawal, the nurse should plan interventions that keep the client safe and treat the physical complications of alcohol withdrawal. The nurse should use the CIWA-Ar screening tool to determine the severity of withdrawal. Withdrawal seizures can occur 12 to 24 hr after cessation of alcohol use; therefore, the nurse should initiate seizure precautions to prevent client injury. The nurse should plan to administer chlordiazepoxide, a benzodiazepine, to decrease agitation, hallucination, and tremors. The nurse should place the client in a quiet environment with minimal stimuli to decrease agitation and the risk for seizures. The nurse should administer thiamine to prevent or treat Wernicke encephalopathy.

A nurse is reinforcing teaching with a client who is pregnant. Exhibit 1 Nurses' Notes Week 6 of gestation: Spoke with client over the phone. Client reports nausea and vomiting with a weight loss of 0.9 kg (2 lb) from their pre-pregnancy weight. Client reports no noted change in voiding pattern and denies dry mucus membranes. Reminded client to eat small frequent meals of non-greasy, dry, sweet, or salty foods such as dry toast, crackers, and pretzels. Encouraged client to call back if nausea and vomiting worsens.Week 10 of gestation: Spoke with client over the phone. Client reports a 6.8 kg (15 lb) weight loss over the past month. Client states nausea continues, making it difficult to eat. They describe a diet of water, toast, and pretzels because other foods are unappealing. They report tolerating a cup of black coffee each morning. Encouraged client to be seen by the provider today.

Complete the following sentence by using the lists of options. The client is at risk for experiencing metabolic acidosis due to the client's weight loss When prioritizing hypotheses, the nurse should recognize that the client is at risk for developing metabolic acidosis due to excessive weight loss. The intake and retention of food is not meeting the client's nutritional requirements. Undernutrition can lead to the breakdown of fatty tissue, which increases the release of nonvolatile acids into the blood stream.

A nurse is assisting in the care of a client who is postoperative following administration of general anesthesia. Exhibit 1 Nurses' Notes 0830: Client is postoperative following an inguinal hernia repair.Apical pulse 154/min and irregularClient reports dyspnea Exhibit 2 Diagnostic Results 0835: Arterial blood gases (ABGs):pH 7.30 (7.35 to 7.45)PCO2 64 mm Hg (35 to 45 mm Hg)HCO3- 26 mEq/L (21 to 28 mEq/L)PO2 80 mm Hg (80 to 100 mm Hg) Exhibit 3 Vital Signs 0830: Temperature 36.9° C (98.4° F)Heart rate 134/minRespiratory rate 28/minBlood pressure 92/52 mm HgPulse oximetry 89% on room air

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. Upon collecting data, the nurse should note the client cues of tachycardia, tachypnea, hypotension, and irregular heart rhythm. The nurse should determine that this client is most likely experiencing malignant hyperthermia, and that it is important to generate solutions and take actions that will correct dysrhythmias, provide oxygen to tissues, correct electrolyte imbalances, and reverse metabolic and respiratory acidosis. Therefore, the nurse should assist the RN with the administration of dantrolene and oxygen. The nurse should also assist the RN to monitor the PCO2 level on the client's ABGs for hypercapnia and observe the client for muscle rigidity of the jaw and chest muscles.

A nurse is assisting with care of a client who is on 24-hr observation. Exhibit 1 Laboratory Results ​0530: Sodium 150 mEq/L (136 to 145 mEq/L) Potassium 5.5 mEq/L (3.5 to 5 mEq/L) Chloride 105 mEq/L (98 to 106 mEq/L) BUN 17 mg/dL (10 to 20 mg/dL) Magnesium 1.2 mEq/L (1.3 to 2.1 mEq/L) Total calcium 10.0 mg/dL (9 to 10.5 mg/dL) Phosphate 4.0 mg/dL (3 to 4.5 mg/dL) Glucose 135 mg/dL (74 to 106 mg/dL) Platelet count 99,500/mm3 (150,000 to 400,000/mm3) WBC count 9,500/mm3 (5,000 to 10,000/mm3) Total protein 4.0 g/dL (6.4 to 8.3 g/dL) Albumin 1.5 g/dL (3.5 to 5 g/dL) Blood alcohol content (EtOH) 200 mg/dL (0 to 50 mg/dL) Exhibit 2 History and Physical ​0600: Client admitted for 24-hr observation for alcohol intoxication. History of alcohol use disorder per family. Client alert and oriented to person. Client appears lethargic. Diminished lung sounds auscultated in bilateral lower lobes. Heart is tachycardic. Nausea an

Complete the following sentence by using the lists of options. The client is at risk for developing hemorrhaging due to thrombocytopenia .

A nurse is caring for a client in an outpatient setting. Exhibit 1 Nurses' Notes 1500: Client reports a recent history dyspnea and fatigue with mild activity. Notes shortness of breath when lying flat. Lips and mucus membranes pale in color. Respirations easy and unlabored at rest. Apical pulse strong and regular with audible S3. Crackles auscultated in lower lobes bilaterally. Abdomen soft and nondistended. Extremities cool to touch. +1 pedal pulses palpated bilaterally. Exhibit 2 History and Physical ​1500: Diagnosed with hypertension 5 years ago. Metoprolol prescription increased 6 months ago from 50 mg daily to 100 mg daily. Exhibit 3 Vital Signs ​1500: Temperature 36.5° C (97.7° F) Heart rate 92/min Respiratory rate 20/min Blood pressure 154/92 mm Hg Oxygen saturation 96% on room air Exhibit 4 Diagnostic Results ​1600: ECG reveals sinus tachycardia at a rate of 104/min. Brain natriuretic peptide (BNP) 50

Complete the following sentence by using the lists of options. The client is exhibiting manifestations of heart failure as evidenced by the client's BNP level When analyzing cues, the nurse should determine that the client is exhibiting manifestations of heart failure as evidenced by the client's BNP level. The client is experiencing dyspnea and fatigue, which might be manifestations of decreased cardiac output. Auscultation of S3 is an early indication of heart failure. A BNP level greater than 400 pg/mL is associated with heart failure. Chronic hypertension leads to myocardial hypertrophy and decreased ability of the heart to fill during diastole and is a common cause of heart failure.

A nurse is assisting with the care of a preschooler. Exhibit 1 Nurses' Notes Day 1 0900: Child admitted to respiratory unit from pediatrician's office. Parents at bedside. Parents state child has been sick with a cold and fever for 3 days. Developed vomiting and diarrhea 1 day ago. Child alert and oriented. S1 and S2 sounds present. Child has productive cough. Rhonchi auscultated on left lower lung. Mild retractions. Child placed on 2 L nasal cannula. Abdomen soft and nontender. Bowel sounds diminished in all four quadrants. Parent states the child has refused food and water for the past 24 hr. Mucus membranes dry. 0930: 30 mL of urine in bedside commode. Arterial blood gas sample obtained from left brachial artery. No swelling or bleeding noted at site after sample drawn. 24-gauge saline lock placed right cubital fossa on first attempt. No swelling or bleeding noted at the site. Intravenous IV bolus 250 mL 0.9 % sod

Complete the following sentence by using the lists of options. When using the stable vs. unstable priority setting framework, the nurse should plan to first address the child's urinary output, followed by the ABG results. Vomiting, diarrhea, acid and base imbalance along with electrolyte imbalance can lead to metabolic alkalosis. Promptly addressing these deficits can improve the child's condition.

A nurse is assisting with the care of a newborn. Exhibit 1 History and Physical 41 weeks of gestation Spontaneous vaginal delivery with meconium-stained amniotic fluid at 1350 Apgar 7 at 1 min and 9 at 5 min Birth weight 2,500 g (5 lb 5 oz) Maternal urine toxicology positive for marijuana use during pregnancy Maternal blood type A, Rh negative Group B streptococcus β-hemolytic: positive (expected value: negative) Client who gave birth received three doses of intravenous antibiotics while in labor Exhibit 2 Nurses' Notes 1400: Newborn placed skin-to-skin on parent's chest with light blanket over top. Lusty cry. Acrocyanosis noted. Newborn rooting and attempting to latch onto the breast. 1430: Newborn lying quietly on parent's chest. No latch achieved. Acrocyanosis noted. Expiratory grunting and nasal flaring present. Skin loose and dry. Scant amount of green-stained vernix caseosa noted in skin folds.

Complete the following sentence by using the lists of options. The nurse should plan to first collect data about the newborn's respiratory rate , followed by the newborn's heart rate When generating solutions, the nurse should identify that expiratory grunting and nasal flaring are unexpected findings in a newborn and indicate respiratory distress. The presence of meconium-stained amniotic fluid increases the risk that the newborn will develop meconium aspiration syndrome. Therefore, the first action the nurse should take is to collect data about the newborn's respiratory rate, followed by the heart rate. The nurse should perform noninvasive data collection techniques, such as observing the respiratory rate, before more invasive techniques that might stimulate the newborn, such as auscultating the heart rate, to avoid alteration of data.

A nurse is assisting with the care of a 3-month-old infant. Exhibit 1 Nurses' Notes Admission Day (Day 1) Infant admitted for respiratory distress. 0800: Wheezing noted upon auscultation in bilateral lower lobes. Mild subcostal and substernal retractions noted. Mild nasal flaring present. Oxygen via nasal cannula at 1 L/min applied. Skin color is appropriate for genetic background. Mucus membranes are pink and moist. Infant is sleeping in parent's arms. 0900: Infant is breastfeeding. Respiratory rate is increasing while feeding. No change in color of mucus membranes noted. Parent reports infant has not been feeding well over the last 24 hr. Infant has a very large, bulky bowel movement, which is extremely foul-smelling. Parent states that the infant has had these types of stools for weeks, and they are getting larger and more frequent. Exhibit 2 Vital Signs 0800: Respiratory rate 48/minHeart rate 146/minTemperature 3

For each potential provider's prescription, click to specify if the potential prescription is anticipated or contraindicated for the infant. When generating solutions for an infant who has cystic fibrosis, the nurse should anticipate prescriptions that address both the respiratory and gastrointestinal system. The nurse should anticipate a prescription to administer pancreatic enzymes PO within 30 min of breastfeeding to ensure that the digestive enzymes are mixed with breastmilk in the duodenum. The nurse should also anticipate a prescription to administer nebulized dornase alfa 2.5 mg per day to decrease the thickness of the infant's mucus. A prescription to use a flutter mucus clearance device every 2 hr and a prescription to administer nebulized hypertonic saline every 6 hr are both contraindicated for an infant because of their inability to properly use the devices. A prescription to perform airway clearance therapy (ACT) immediately after breastfeeding is contraindicated because performing ACT before or immediately after breastfeeding will interfere with the effectiveness of the treatment.