the nurse is preparing to administer a vaccine to a newborn before administering the vaccine the nurse should
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Nursing Elites

ATI RN

ATI Pathophysiology Exam

1. The nurse is preparing to administer a vaccine to a newborn. Before administering the vaccine, the nurse should

Correct answer: C

Rationale: Before administering a vaccine to a newborn, it is essential for the nurse to check the infant's temperature. This is important to ensure that the newborn does not have a fever, which could indicate an underlying infection or illness. Warming the vaccine to room temperature is not necessary and could be harmful. Vigorously massaging the injection site is not recommended as it can cause discomfort and tissue damage. Dividing the dose for administration to three injection sites is not standard practice for vaccine administration to a newborn.

2. When starting on oral contraceptives, what should the nurse include in the education regarding the timing of the medication?

Correct answer: A

Rationale: When educating a patient starting on oral contraceptives, it is essential to stress the importance of taking the medication at the same time each day. This ensures stable hormone levels, improving the effectiveness of the contraceptives in preventing pregnancy. Choice B is incorrect because consistency in timing is crucial for maintaining hormone levels. Choice C is incorrect as there is no specific requirement to take oral contraceptives in the morning to avoid side effects. Choice D is incorrect as oral contraceptives may take some time to become fully effective, and consistent timing is important for their efficacy.

3. A 30-year-old woman is taking an oral contraceptive and is concerned about the potential side effects. What should the nurse include in the patient education?

Correct answer: C

Rationale: The correct answer is C: 'Oral contraceptives can cause headaches and breast tenderness.' It is essential for the nurse to educate the patient about common side effects of oral contraceptives, such as headaches and breast tenderness. Choices A, B, and D are incorrect. Weight loss and increased energy levels (Choice A) are not common side effects of oral contraceptives. Similarly, increased appetite and weight gain (Choice B) are not typical side effects. Finally, stating that oral contraceptives have no side effects (Choice D) is inaccurate as they can have various side effects, albeit usually mild and manageable.

4. What important instruction should the nurse provide regarding the application of testosterone gel in a patient with hypogonadism?

Correct answer: A

Rationale: The correct instruction for applying testosterone gel in a patient with hypogonadism is to apply it to the chest or upper arms and allow it to dry completely before dressing. This method helps avoid transfer to others. Applying the gel to the face, neck, or genitals is not recommended as it can lead to unintended exposure to others. Additionally, applying the gel to the scalp and back is not a standard or effective route of administration for testosterone gel. Therefore, choice A is the correct answer as it ensures proper application and safety.

5. During admission, 82-year-old Mr. Robeson is brought to the medical-surgical unit for diagnostic confirmation and management of probable delirium. Which statement by the client’s daughter best supports the diagnosis?

Correct answer: B

Rationale: The correct answer is B because sudden onset of behavioral changes is a typical symptom of delirium. Delirium is characterized by an acute and fluctuating disturbance in attention, awareness, and cognition. Choice A is incorrect because delirium is not a normal part of aging. Choice C describes memory issues, which can be seen in delirium but are less specific than sudden behavioral changes. Choice D, while it mentions the patient's independence, does not directly support the diagnosis of delirium.

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