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National Council Licensure Examination - NCLEX-RN Questions 236–238 (page: 96)

Updated On: 9-Feb-2026

After the RN is finished the initial assessment of a newborn baby and after the initial bonding between the newborn and the mother has taken place in the delivery room, the RN will bring the newborn to the well-baby nursery. Before the newborn is taken from the delivery room and brought to the well-baby nursery, the RN makes sure that which of the following interventions was completed?

  1. The physician verifies the exact time of birth.
  2. The nurse counts the instruments and sponges with the scrub nurse.
  3. The nurse instills prophylactic ointment in the conjunctival sacs of the newborn's eyes.
  4. The nurse makes sure the mother and her newborn have been tagged with identical bands.

Answer(s): D

Explanation:

(A) The delivery room personnel are responsible for verifying time of birth. (B) The scrub and circulating nurses count sponges and instruments. (C) This intervention is done in the nursery. (D) Tagging the mother and infant with identical bands is of utmost importance. The mother wears one band, and the newborn wears two. Identical numbers on the three bands provide identification for the newborn and the birth mother. Every time the newborn is brought to the mother after delivery, those bands are checked to be sure that the numbers are identical.



After the RN is finished the initial assessment of a newborn baby and after the initial bonding between the newborn and the mother has taken place in the delivery room, the RN will bring the newborn to the well-baby nursery. Before the newborn is taken from the delivery room and brought to the well-baby nursery, the RN makes sure that which of the following interventions was completed?

  1. The physician verifies the exact time of birth.
  2. The nurse counts the instruments and sponges with the scrub nurse.
  3. The nurse instills prophylactic ointment in the conjunctival sacs of the newborn's eyes.
  4. The nurse makes sure the mother and her newborn have been tagged with identical bands.

Answer(s): D

Explanation:

(A) The delivery room personnel are responsible for verifying time of birth. (B) The scrub and circulating nurses count sponges and instruments. (C) This intervention is done in the nursery. (D) Tagging the mother and infant with identical bands is of utmost importance. The mother wears one band, and the newborn wears two. Identical numbers on the three bands provide identification for the newborn and the birth mother. Every time the newborn is brought to the mother after delivery, those bands are checked to be sure that the numbers are identical.



A 1000-mL dose of D5W 12 normal saline is to be infused in 8 hours. The drop factor for the tubing is 60 gtt/min. How many drops per minute should the nurse administer?

  1. 75 gtt/min
  2. 100 gtt/min
  3. 125 gtt/min
  4. 150 gtt/min

Answer(s): C

Explanation:

(A) This answer is a miscalculation. (B) This answer is a miscalculation. (C)125 gtt/min. (D) This answer is a miscalculation.



A 1000-mL dose of D5W 12 normal saline is to be infused in 8 hours. The drop factor for the tubing is 60 gtt/min. How many drops per minute should the nurse administer?

  1. 75 gtt/min
  2. 100 gtt/min
  3. 125 gtt/min
  4. 150 gtt/min

Answer(s): C

Explanation:

(A) This answer is a miscalculation. (B) This answer is a miscalculation. (C)125 gtt/min. (D) This answer is a miscalculation.



When planning care for the passive-aggressive client, the nurse includes the following goal:

  1. Allow the client to use humor, because this may be the only way this client can express self.
  2. Allow the client to express anger by using "I" messages, such as "I was angry when . . .," etc.
  3. Allow the client to have time away from therapeutic responsibilities.
  4. Allow the client to give excuses if he forgets to give staff information.

Answer(s): B

Explanation:

(A) Ceasing to use humor and sarcasm is a more appropriate goal, because this client uses these behaviors covertly to express aggression instead of being open with anger. (B) Use of "I" messages demonstrates proper use of assertive behavior to express anger instead of passive-aggressive behavior. (C) Client is expected to complete share of work in therapeutic community because he has often obstructed other's efforts by failing to do his share. (D) Client has used conveniently forgetting or withholding information as a passive-aggressive behavior, which is not acceptable.



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