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A nurse is attempting to resuscitate a neonate. After following the Neonatal Resuscitation Program guidelines, 30 seconds of chest compressions have been completed. The neonate's heart rate remains less than 60 bpm. Epinephrine is to be given. What is the expected outcome for a neonate who has received epinephrine during resuscitation?
- A. Increased urine output.
- B. A normal heart rate.
- C. Pain relief.
- D. Sedation.
Correct Answer: B
Rationale: Epinephrine is used to restore a normal heart rate during resuscitation by stimulating cardiac activity.
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A nurse is reviewing a client's maternal prenatal record and notes that the mother used narcotics during her pregnancy. A primary nursing intervention when caring for a drug-exposed neonate is to:
- A. Assess vital signs including blood pressure every hour.
- B. Minimize environmental stimuli.
- C. Place the infant in a well-lighted area for observation.
- D. Provide stimulation to increase adaptation to the environment.
Correct Answer: B
Rationale: Minimizing environmental stimuli reduces stress and overstimulation in drug-exposed neonates, who are often hypersensitive.
In response to the nurse's question about how she is feeling, a postpartum client states that she is fine. She then begins talking to the baby, checking the diaper, and asking infant care questions. The nurse determines the client is in which postpartal phase of psychological adaptation?
- A. Taking in.
- B. Taking on.
- C. Taking hold.
- D. Letting go.
Correct Answer: C
Rationale: The 'taking hold' phase is characterized by the mother becoming more active, showing interest in caring for the infant, and asking questions about infant care, as described in the scenario.
Three days after admission of a neonate delivered at 30 weeks' gestation, the neonatologist plans to assess the neonate for periventricular-intraventricular hemorrhage (PIVH). The nurse should plan to assist the neonatologist by preparing the neonate for which of the following?
- A. Computed tomography scan.
- B. Arterial blood specimen collection.
- C. Radiographs of the skull.
- D. Complete blood count specimen collection.
Correct Answer: A
Rationale: A computed tomography scan is used to assess for PIVH, as it visualizes bleeding in the brain.
As the nurse enters the room of a newly admitted primigravid client diagnosed with severe preeclampsia, the client begins to experience a seizure. Which of the following should the nurse do first?
- A. Insert an airway to improve oxygenation.
- B. Note the time when the seizure begins and ends.
- C. Call for immediate assistance.
- D. Turn the client to her left side.
Correct Answer: D
Rationale: Turning the client to her left side helps maintain airway patency and prevents aspiration.
A client asks about the risks of the copper IUD. Which of the following would the nurse include?
- A. It may increase menstrual bleeding and cramping.
- B. It causes permanent infertility.
- C. It requires daily replacement.
- D. It increases the risk of breast cancer.
Correct Answer: A
Rationale: The copper IUD may increase menstrual bleeding and cramping, especially initially. It does not cause permanent infertility, require daily replacement, or increase breast cancer risk.