Which of the following interventions is recommended for managing a patient with a suspected opioid overdose?

Correct Answer: A

Rationale: Naloxone is a medication used to reverse the effects of an opioid overdose by binding to opioid receptors and displacing the opioids. Administering naloxone intravenously is the recommended intervention for managing a patient with a suspected opioid overdose as it can quickly reverse respiratory depression, sedation, and other effects of opioids. This intervention can be life-saving in cases of opioid overdose and is a critical step in the management of such patients. Providing respiratory support with bag-valve-mask ventilation may be necessary in addition to naloxone administration to ensure adequate oxygenation, but naloxone remains the primary intervention to reverse the effects of opioids. Encouraging the patient to drink fluids rapidly or administering benzodiazepines for sedation are not recommended interventions for managing a suspected opioid overdose.

Correct Answer: A

Rationale: Shoulder dystocia is an obstetric emergency where one of the baby's shoulders becomes impacted behind the mother's pubic bone after the head delivers. This can lead to compression of the umbilical cord and compromise fetal oxygenation. The most critical nursing intervention in managing shoulder dystocia is applying suprapubic pressure to dislodge the impacted shoulder and allow for delivery of the baby. By gently pushing downwards on the mother's abdomen just above the pubic bone, the shoulder can be released, and the baby can be delivered successfully. This intervention should be prioritized to prevent potential complications for both the mother and the baby. Episiotomy may be considered if necessary, but it is secondary to addressing the shoulder dystocia. Oropharyngeal airway insertion and administering magnesium sulfate are not indicated in the immediate management of shoulder dystocia.

Correct Answer: D

Rationale: Physiologic jaundice among newborn babies typically occurs between the 2nd and the 3rd day after birth. This type of jaundice is considered normal and harmless and is caused by the breakdown of red blood cells and the immaturity of the newborn baby's liver in processing bilirubin. The bilirubin levels rise in the blood, leading to a yellowish discoloration of the skin and eyes. This type of jaundice usually peaks around the 3rd to 4th day after birth and then gradually resolves without treatment within the first week of life. It is important for healthcare providers to monitor bilirubin levels and ensure that they do not reach dangerous levels that could potentially harm the newborn.

Correct Answer: D

Rationale: A patient with chronic kidney disease prescribed a low-protein diet should avoid high-protein foods like grilled salmon, lentil soup, and beef stew. Chicken Caesar salad, on the other hand, typically contains a smaller amount of protein compared to the other options. This choice indicates an understanding of the need to limit protein intake while still enjoying a balanced meal. However, it is important to note that the quantity and portion sizes of high-protein ingredients in the salad should also be moderate to comply with a low-protein diet.

Correct Answer: C

Rationale: The main source of nutrition for the baby during pregnancy is the placenta. The placenta is an organ that develops inside the uterus during pregnancy and provides essential nutrients and oxygen from the mother's blood to the baby through the umbilical cord. It acts as a barrier, protecting the baby from harmful substances while allowing necessary nutrients to pass through. The amniotic fluid serves as a protective cushion for the baby, the uterus provides the space for the baby to grow, and chorionic villi are small, hair-like structures on the placenta that aid in the exchange of nutrients and waste between the mother and the baby. However, the primary source of nutrition for the baby is the placenta, making option C the correct answer in this scenario.

Correct Answer: C

Rationale: Choosing option C, asking the patient about their cultural beliefs and preferences related to pain, demonstrates cultural competence in pain assessment. Pain experiences can vary greatly across different cultures, and a patient's cultural background can influence how they perceive and express pain. By inquiring about the patient's cultural beliefs and preferences, the nurse can gain a better understanding of the patient's perspective on pain. This information is crucial for providing individualized and culturally sensitive pain management interventions. It also shows respect for the patient's unique cultural background and helps build a trusting and collaborative relationship between the nurse and the patient.

Correct Answer: D

Rationale: After childbirth, the uterus undergoes involution, which is the process of returning to its pre-pregnant size and location. Initially, the fundus is firm and located at or just below the level of the umbilicus immediately after delivery. Over the next 24 hours, the fundus should gradually decrease in height as involution progresses. By the day after delivery, the nurse would expect the fundal assessment to be in line with the umbilicus or slightly below it, indicating normal involution of the uterus. If the fundus remains high or deviates from this expected progression, further assessment and intervention may be needed to prevent complications such as postpartum hemorrhage.

Correct Answer: B

Rationale: When a patient with a suspected spinal injury is found unconscious, the priority action is to secure the airway without jeopardizing the cervical spine. A jaw thrust maneuver is the appropriate technique to open the airway in this situation because it allows for the maintenance of neutral alignment of the cervical spine while ensuring proper ventilation. Moving the patient to a flat surface or applying a cervical collar could potentially worsen the spinal injury if not done correctly, and checking for responsiveness should only be done after ensuring a patent airway. Therefore, the safest and most effective initial action is to perform a jaw thrust maneuver to establish a clear airway.

Correct Answer: A

Rationale: For a preschooler, it is recommended that they get more than 8 hours of sleep each day. Adequate sleep is crucial for their physical development, overall health, and cognitive function. Preschoolers typically need around 10-13 hours of sleep per day to support their growth and development. Getting less than the recommended amount of sleep can lead to issues such as behavioral problems, difficulty concentrating, and poor physical development. Therefore, ensuring that a preschooler gets enough sleep is vital for their physical well-being.