Nokea
A neonate has a large amount of secretions. After vigorously suctioning the neonate, the nurse should assess for what possible result?
- A. Bradycardia.
- B. Rapid eye movement.
- C. Sickness.
- D. Tachycardia.
Correct Answer: A
Rationale: Vigorous suctioning can stimulate the vagus nerve, leading to bradycardia in a neonate.
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A 28-year-old multigravida at 37 weeks' gestation arrives at the emergency department with a blood pressure of 160/104 mm Hg and +3 reflexes without clonus. The client is diagnosed with severe preeclampsia. The nurse collaborates with the health care provider to develop a plan of care that care will first include:
- A. Administration of glucocorticoids(Betamethasone).
- B. Vaginal or cesarean delivery of the fetus.
- C. Prevention of seizures with phenytoin (Dilantin).
- D. Reduction of fluid retention with thiazides.
Correct Answer: B
Rationale: Delivery is the definitive treatment for severe preeclampsia.
The physician orders ampicillin The dose is 100 mg/kg per dose for a newly admitted neonate. The neonate weighs 1,350 grams. How many milligrams should the nurse administer?
- A. mg.
Correct Answer: B
Rationale: The neonate weighs 1,350 g (1.35 kg). The dose is 100 mg/kg, so 100 mg/kg × 1.35 kg = 135 mg. The nurse should administer 135 mg.
The nurse has received shift report on a group of newborns. The nurse should make rounds on which of the following clients first?
- A. A newborn who is large for gestational age (LGA) who needs a repeat blood glucose prior to the next feeding in 15 minutes.
- B. A newborn delivered at 36-weeks' gestation weighing $5 \mathrm{lb}$ who is due to breast-feed for the first time in 15 minutes.
- C. A newborn who was delivered 24 hours ago by Cesarean section and had a respiratory rate of 62 30 minutes ago.
- D. A newborn who had a borderline low temperature and was double-wrapped with a hat on ½ hour ago to bring up the temperature.
Correct Answer: C
Rationale: A respiratory rate of 62 is elevated and may indicate respiratory distress, requiring immediate assessment.
A primiparous client, 4 hours postpartum, reports feeling overwhelmed and anxious about caring for her newborn. Which nursing intervention is most appropriate?
- A. Encourage the client to rest and limit visitors.
- B. Teach the client basic newborn care skills immediately.
- C. Administer an anxiolytic medication as prescribed.
- D. Refer the client to a social worker for counseling.
Correct Answer: B
Rationale: Teaching basic newborn care skills empowers the client, reduces anxiety, and promotes confidence in the early postpartum period.
A 25-year-old primiparous client who delivered a viable neonate 2 hours ago has decided to breast-feed her neonate. Which of the following instructions should the nurse address as the highest priority in the teaching plan about preventing nipple soreness?
- A. Keeping plastic liners in the brassiere to keep the nipple drier.
- B. Placing as much of the areola as possible into the baby's mouth.
- C. Smoothly pulling the nipple out of the mouth after 10 minutes.
- D. Removing any remaining milk left on the nipple with a soft washcloth.
Correct Answer: B
Rationale: Proper latch with the areola in the baby's mouth prevents nipple soreness by reducing trauma.