A charge nurse in a newborn nursery is providing information to a group of nurses about risk factors for hypoglycemia. Which of the following risk factors should the charge nurse include? (Select all that apply.)

Maternal diabetes

Prematurity

Hypothermia

Thrombocytopenia

Anemia

Answer and Explanation

Correct Answer : A,B,C

Rationale:

A. Maternal diabetes: Infants born to diabetic mothers are at increased risk for hypoglycemia due to elevated insulin levels stimulated by maternal hyperglycemia. After birth, the abrupt loss of maternal glucose can lead to a rapid drop in the infant’s blood sugar.

B. Prematurity: Premature infants have limited glycogen stores and immature metabolic systems, making them more susceptible to hypoglycemia. Their inability to effectively regulate glucose levels increases their risk after birth.

C. Hypothermia: Cold stress increases metabolic demands and glucose consumption. As the infant uses more energy to maintain body temperature, blood glucose levels can drop rapidly if not closely monitored and managed.

D. Thrombocytopenia: Low platelet counts may indicate other underlying conditions but are not directly associated with hypoglycemia. It is more relevant to clotting and bleeding risks rather than glucose regulation.

E. Anemia: Anemia affects oxygen-carrying capacity but does not have a direct link to blood glucose control. While it may indicate other health issues, it is not a recognized independent risk factor for neonatal hypoglycemia.

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Correct Answer is C

Explanation

Rationale:

A. The client experiences self-doubt when making decisions: Indecisiveness and self-doubt are common symptoms of major depressive disorder and do not reflect improvement. They typically indicate ongoing low self-esteem and cognitive impairment.

B. The client exhibits a flat affect: A flat or blunted affect is a hallmark of depressive states. Persistence of this symptom suggests the depression is still significantly impacting the client’s emotional expression.

C. The client can express angry feelings: Being able to express emotions such as anger can indicate emotional engagement and increased energy, which are signs of clinical improvement in depression.

D. The client looks down when speaking to others: This behavior suggests ongoing feelings of worthlessness or poor self-confidence, commonly seen in depressive states and not indicative of recovery.

A. Frequent swallowing B. Increased drowsiness C. Elevated pain level D. Diminished breath sounds

Correct Answer is A

Explanation

Rationale:

A. Frequent swallowing: Frequent swallowing, especially of small amounts, can indicate that the child is swallowing blood from postoperative bleeding. This is a common early sign of hemorrhage following a tonsillectomy and requires immediate evaluation.

B. Increased drowsiness: Drowsiness can result from anesthesia, pain medication, or fatigue after surgery. While it should be monitored, it is not a specific indicator of postoperative hemorrhage in a child following tonsillectomy.

C. Elevated pain level: Pain is expected after tonsillectomy and does not necessarily signal bleeding. Sudden severe pain might warrant reassessment, but elevated pain alone is not a definitive sign of hemorrhage.

D. Diminished breath sounds: Diminished breath sounds are not typically associated with post-tonsillectomy hemorrhage. This finding may indicate a respiratory issue, but not specifically bleeding from the surgical site.

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A charge nurse in a newborn nursery is providing information to a group of nurses about risk factors for hypoglycemia. Which of the following risk factors should the charge nurse include? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has major depressive disorder. Which of the following findings should indicate to the nurse that the client's condition is improving?

Correct Answer is C

Explanation

A nurse is caring for a child who is postoperative following a tonsillectomy. Which of the following findings indicates that the child may be experiencing hemorrhage?

Correct Answer is A

Explanation

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