Nokea
Based on the following risk factors, which newborn is least at risk for developing persistent pulmonary hypertension? Select all that apply.
- A. Late or postdates delivery
- B. Born to a mother with gestational diabetes
- C. Appropriate for gestational age
- D. Meconium aspiration
Correct Answer: C
Rationale: The correct answer is C: Appropriate for gestational age. Newborns who are appropriate for gestational age are least at risk for developing persistent pulmonary hypertension because they have not experienced intrauterine growth restriction or other complications that can lead to lung problems. Being born late or postdates (A) can increase the risk of complications, including pulmonary hypertension. Being born to a mother with gestational diabetes (B) can also increase the risk due to potential metabolic issues. Meconium aspiration (D) can lead to respiratory distress and increase the risk of pulmonary hypertension.
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Which rationale is true regarding jaundice in newborns?
- A. Jaundice can result in a newborn when the mother and newborn have the same blood type.
- B. A mother who breastfeeds her newborn who develops jaundice may have to begin formula temporarily.
- C. Bilirubin levels will drop in newborns who have jaundice and may cause brain abnormalities.
- D. Keeping a newborn with jaundice below 98.7°F is essential in lowering bilirubin levels.
Correct Answer: B
Rationale: Step 1: Breast milk jaundice is a common cause of jaundice in newborns due to a substance in breast milk that can increase bilirubin levels.
Step 2: Switching to formula temporarily can help resolve the issue as formula-fed babies have lower incidences of jaundice.
Step 3: This is supported by medical guidelines recommending temporary cessation of breastfeeding in cases of severe jaundice.
Summary:
A: Blood type compatibility does not directly cause jaundice in newborns.
C: Bilirubin levels need to be monitored and managed in newborns with jaundice to prevent brain damage.
D: Maintaining a specific temperature is not the primary method of managing jaundice in newborns.
Which intervention should the nurse instruct the parents to do for their newborn who has acute diaper rash?
- A. Apply the diaper loosely to infant, allowing for better air circulation.
- B. Change the newborn every 4 hours to prevent a moist environment.
- C. Wash the newborn’s diaper area with an antibacterial soap and newborn wipes.
- D. Wipe off the diaper cream thoroughly between diaper changes.
Correct Answer: A
Rationale: The correct answer is A: Apply the diaper loosely to infant, allowing for better air circulation. This is the best intervention for acute diaper rash as it helps reduce moisture and promotes healing. Tight diapers trap moisture, worsening the rash. Choice B is incorrect as changing every 2-3 hours is recommended to maintain a dry environment. Choice C is incorrect as antibacterial soap can be harsh and disrupt the skin's natural flora. Choice D is incorrect as wiping off diaper cream thoroughly can irritate the skin further.
A 3-month-old has pulled out their NG tube at home, and the mother is now speaking with the on-call nurse. What recommendation should the nurse provide her?
- A. drive the infant to the nearest ER
- B. Call 911 and wait for EMS to arrive
- C. attempt to replace the NG tube yourself following discharge training
- D. feed the infant by mouth as there is not an NG tube to use
Correct Answer: C
Rationale: The correct answer is C because the mother was trained on NG tube replacement. This knowledge ensures proper technique and reduces the risk of injury. Driving to the ER or calling 911 may waste time, and feeding by mouth without the NG tube is not safe. Replacing the NG tube at home is the most efficient and appropriate course of action in this scenario.
Whose baby is at highest risk of developing jaundice based on risk factors?
- A. A 16-year-old mother who labored with Pitocin and had an uncomplicated delivery.
- B. A 23-year-old mother who made it to the hospital after a delivery at home, umbilical cord cut at the hospital.
- C. A 28-year-old mother with type A blood and a father with O+ blood type delivered a newborn with nuchal cord x2; forceps used
- D. A 30-year-old mother who delivered twins via cesarean section; newborn A was breech; father unknown
Correct Answer: C
Rationale: The correct answer is C because the newborn has both type A blood (from the mother) and O+ blood (from the father), leading to a higher risk of jaundice due to ABO incompatibility. The presence of nuchal cord x2 and the use of forceps during delivery also increase the risk of newborn jaundice.
Choice A is incorrect because the mother's age and use of Pitocin do not inherently increase the risk of jaundice. Choice B is incorrect because the baby being born at home and the timing of the umbilical cord cutting are not directly related to jaundice risk. Choice D is incorrect because the method of delivery and the father's unknown blood type do not specifically indicate a high risk of jaundice compared to the scenario in Choice C.
Which clinical sign is most concerning immediately following the delivery of a high-risk neonate?
- A. Axillary temperature of 97.8°F
- B. Blood glucose of 35 g/dL
- C. Oxygen saturation of 90%
- D. Blue-tinged hands and feet
Correct Answer: B
Rationale: The correct answer is B: Blood glucose of 35 g/dL. This is the most concerning sign as hypoglycemia in neonates can lead to serious neurological complications. Low blood glucose levels can result in seizures, brain damage, and even death if not promptly addressed. It is crucial to maintain appropriate blood glucose levels in neonates to support their brain development and overall health.
Explanation of other choices:
A: Axillary temperature of 97.8°F - Slightly below normal but not immediately concerning.
C: Oxygen saturation of 90% - Suboptimal but not as critical as severe hypoglycemia.
D: Blue-tinged hands and feet - Could indicate poor circulation, but hypoglycemia is more urgent to address.