Nokea
The nurses in a NICU are concerned about the appropriate levels of oxygen therapy during the care of premature neonates. The nurses referenced an article by Newman (2014) titled, “Oxygen Saturation Limits and Evidence supporting the Targets.” On which evidence-based conclusion will the nurses develop guidelines?
- A. Oxygen saturation limits of 85% to 89% are effective.
- B. Oxygen saturation rates of 91% to 95% are effective.
- C. Infants are within saturation limits about 75% of the time.
- D. Oxygen saturation limits need to be between 87% to 94%.
Correct Answer: B
Rationale: The correct answer is B: Oxygen saturation rates of 91% to 95% are effective. This range is supported by the article by Newman (2014) as the optimal oxygen saturation levels for premature neonates. Here's the rationale:
1. The range of 91% to 95% falls within the typical target range for oxygen saturation in premature neonates, ensuring adequate oxygenation without the risk of hyperoxia or hypoxia.
2. Maintaining oxygen saturation within this range has been shown to improve outcomes and reduce the risk of complications in premature neonates.
3. The article by Newman likely provides evidence-based research supporting this specific range as the most effective for neonatal care.
In summary, choices A, C, and D are incorrect because they do not align with the evidence-based optimal oxygen saturation range for premature neonates as supported by the referenced article.
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Which characteristics are typically found in a patient diagnosed with Down syndrome? Select all that apply.
- A. Low-set ears
- B. Broad nasal bridge
- C. Round occiput
- D. Small tongue
Correct Answer: C
Rationale: The correct answer is C: Round occiput. In Down syndrome, individuals often exhibit a round-shaped head at the back (occiput) due to the abnormal growth patterns of the skull bones. This characteristic is a common physical feature seen in individuals with Down syndrome.
A: Low-set ears - While low-set ears can be a feature in some cases of Down syndrome, it is not a defining characteristic and not always present.
B: Broad nasal bridge - Broad nasal bridge is a common feature in Down syndrome, but it is not specific enough to be a defining characteristic.
D: Small tongue - While individuals with Down syndrome may have slightly smaller tongues compared to the general population, it is not a prominent characteristic and not typically used for diagnosis.
The nurse has access to the results of a karyotype sent out for their patient via an electronic medical record. The parents have accessed the results on their MyChart phone application and have asked the nurse what the results 45, X mean. What is the best response from the nurse?
- A. The results indicate your child may have Turner syndrome.
- B. Your results are 45, X; you will have to wait to talk with the geneticist.
- C. Your results indicate that your daughter has a serious lifelong disease.
- D. I’m not sure; I’ll call the provider.
Correct Answer: A
Rationale: The correct answer is A: The results indicate your child may have Turner syndrome. This is the best response because 45, X is the karyotype typically associated with Turner syndrome, a genetic condition where a female is missing part or all of one X chromosome. This response shows the nurse's knowledge of genetics and ability to interpret karyotype results accurately.
Summary of incorrect choices:
B: Your results are 45, X; you will have to wait to talk with the geneticist - This response delays providing crucial information to the parents and does not address their immediate concerns.
C: Your results indicate that your daughter has a serious lifelong disease - This choice is too vague and alarming, lacking specificity about the condition associated with the karyotype results.
D: I’m not sure; I’ll call the provider - This response shows a lack of knowledge on the nurse's part and does not offer any immediate information or reassurance to the parents.
Which patient should be assessed first?
- A. Infant with a blood glucose level of 45 mg/dL, maternal history of gestational diabetes
- B. Infant who is plotted on the growth chart between the 75th and 85th percentile for weight and length and the 50th percentile for head circumference
- C. Infant born at 42 weeks gestation to 40-year-old mother who was otherwise healthy during pregnancy and at the time of delivery
- D. Infant born at 38 weeks gestation with a green stain and bruising noted on initial assessment at delivery
Correct Answer: A
Rationale: The correct answer is A. An infant with a blood glucose level of 45 mg/dL and a maternal history of gestational diabetes should be assessed first to rule out hypoglycemia, which can be life-threatening in newborns. Hypoglycemia can lead to seizures, brain damage, or even death if not promptly treated. Infants born to mothers with gestational diabetes are at higher risk for hypoglycemia due to their own insulin production in response to high maternal glucose levels. Therefore, immediate assessment and intervention are crucial.
Choice B is incorrect because growth parameters within normal ranges do not indicate an immediate need for assessment. Choice C is also incorrect as the mother's age and gestational age do not necessarily indicate an urgent need for assessment. Choice D is incorrect as the presence of a green stain and bruising may indicate meconium aspiration syndrome, but hypoglycemia poses a more immediate threat to the infant's health.
Which causes infants of diabetic mothers to be large for gestational age?
- A. Maternal insulin crosses the placenta and makes the baby large.
- B. Blood flow across the placenta is greater than normal.
- C. Maternal doses of insulin are absorbed by the infant and cause increased body growth.
- D. Maternal glucose crosses the placenta and causes the infant to produce more insulin than usual, resulting in greater body growth.
Correct Answer: D
Rationale: Step 1: Maternal diabetes leads to high blood glucose levels.
Step 2: Maternal glucose crosses the placenta to the fetus.
Step 3: Fetal pancreas produces more insulin in response to high glucose.
Step 4: Excess insulin promotes fetal growth, leading to macrosomia.
Summary:
A: Incorrect - Maternal insulin doesn't cross placenta in significant amounts.
B: Incorrect - Blood flow doesn't directly cause fetal overgrowth.
C: Incorrect - Maternal insulin doesn't directly cause increased growth.
What term best describes an infant born with a birth weight below the 10th percentile for gestational age?
- A. Appropriate for gestational age
- B. Failure to thrive
- C. Small for gestational age
- D. Infant born to mother of gestational diabetes
Correct Answer: C
Rationale: The correct answer is C: Small for gestational age. This term describes an infant born with a birth weight below the 10th percentile for gestational age, indicating intrauterine growth restriction. This term specifically addresses the infant's size in relation to their gestational age, distinguishing it from other choices.
A: Appropriate for gestational age refers to infants whose birth weight falls within the normal range for their gestational age, not below the 10th percentile.
B: Failure to thrive is a broader term encompassing various factors affecting a child's growth and development, not specifically related to birth weight percentile.
D: Infant born to mother of gestational diabetes pertains to a specific maternal condition that may affect the infant's health but does not directly address the infant's birth weight percentile.