Nokea
Newborn born 10 hours ago via cesarean section, moist lung sounds
A nursing student is helping the nursery nurses with morning vital signs. A baby born 10 hours ago via cesarean section is found to have moist lung sounds. What is the best interpretation of these data?
- A. If this baby was born vaginally, it could indicate a pneumothorax.
- B. The neonate must have aspirated surfactant.
- C. The lungs of a baby delivered by cesarean section may sound moist for 24 hours after birth.
- D. The nurse should notify the pediatrician stat for this emergency situation.
Correct Answer: C
Rationale: Babies born via cesarean section often have moist lung sounds due to retained fluid, as they miss the chest compression of vaginal delivery, and this typically resolves within 24 hours.
You may also like to solve these questions
Newborn born at 37 weeks, 12 hours old, tachypnea, grunting, nasal flaring, substernal retractions, acrocyanosis
Complete the diagram by dragging from the choices below to specify what condition the newborn is most likely experiencing, two actions the nurse should take to address that condition, and two parameters the nurse should monitor to assess the newborn's progress.
- A. Initiate phototherapy as prescribed.
- B. Obtain a urine drug screen.
- C. Administer Surfactant as prescribed.
- D. Administer 30 mL of oral glucose water.
- E. Provide Oxygen Therapy as needed
- F. Hypoglycemia.
- G. Respiratory distress syndrome.
Correct Answer: B
Rationale: Respiratory distress syndrome is likely due to respiratory symptoms. Administer surfactant and provide oxygen therapy address lung immaturity and oxygenation. Monitor arterial blood gases and oxygen saturation to assess progress.
New mother, postpartum period
Choose the sign or symptom that a new mother should be taught to report:
- A. Occasional uterine cramping when the infant nurses.
- B. Descent of the fundus one fingerbreadth each day.
- C. Reappearance of red lochia after it changes to serous.
- D. Oral temperature that is 37.2 C (99 F) in the morning.
Correct Answer: C
Rationale: Reappearance of red lochia after it becomes serous may indicate uterine atony or retained placental fragments, requiring immediate reporting.
Woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday, orders for perineal ice packs, sitz bath, stool softener
A woman gave birth vaginally to a 9-pound, 12-ounce girl yesterday. Her primary health care provider has written orders for perineal ice packs, use of a sitz bath tid, and a stool softener. What information is most closely correlated with these orders?
- A. The woman had a vacuum-assisted birth.
- B. The woman is a gravida 2, para 2.
- C. The woman has an episiotomy.
- D. The woman received epidural anesthesia.
Correct Answer: C
Rationale: An episiotomy correlates with orders for ice packs, sitz baths, and stool softeners, as these address pain and healing of the perineal incision.
Newborn placed under radiant heat warmer after birth
A nurse places a newborn under a radiant heat warmer after birth. The purpose of this action is to prevent which of the following in the newborn?
- A. Basal metabolic rate reduction.
- B. Brown fat production.
- C. Shivering.
- D. Cold stress.
Correct Answer: D
Rationale: A radiant heat warmer prevents cold stress by maintaining the newborn's body temperature, avoiding complications like hypoxia and hypoglycemia.
Infant being weighed
The correct answer is choice A, which is to ensure that conductive heat loss from the infant is minimal
- A. ensure that conductive heat loss from the infant is minimal
- B. compensate for the negative weight balance to ensure the correct weight
- C. avoid causing multiple startle (Moro) reflexes when weighing
- D. avoid contaminating the nurse's hands with blood or other body substances
Correct Answer: A
Rationale: A covering on the scale tray minimizes conductive heat loss by preventing direct contact with the cold scale surface, critical for maintaining the infant's temperature.