A mother refused to allow her son to receive the phytonadione (Mephyton) injection at birth as was stated on her birth plan.Which of the following signs or symptoms might the nurse observe in the baby as a result?
Vital signs are unstable.
Glucose levels are low.
Skin has acrocyanosis.
Circumcision site oozes blood.
The Correct Answer is D
Choice A rationale
Unstable vital signs in a newborn could be attributed to various causes such as infection, respiratory issues, or cardiovascular problems. It is not directly linked to the absence of phytonadione injection.
Choice B rationale
Low glucose levels in a newborn can result from conditions like prematurity, maternal diabetes, or feeding issues and are not a direct consequence of the absence of a phytonadione injection.
Choice C rationale
Acrocyanosis, a bluish discoloration of the hands and feet, is a common and benign finding in newborns due to immature blood circulation and is not related to the absence of phytonadione.
Choice D rationale
Phytonadione (vitamin K) is essential for blood clotting. Absence of this injection can lead to bleeding issues, such as oozing at circumcision sites, due to vitamin K deficiency bleeding (VKDB).
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Related Questions
Correct Answer is A
Explanation
Choice A rationale: Heavy menstrual bleeding after an IUD insertion can be a sign of complications such as displacement of the IUD, infection, or other issues that require medical attention. It's important for the client to come to the clinic as soon as possible to be evaluated by a healthcare provider and ensure everything is functioning properly.
Choice B rationale: Taking her temperature every 4 hours is not directly relevant to the concern of heavy menstrual bleeding unless there is a suspicion of infection, which should still be evaluated in the clinic.
Choice C rationale: While some spotting or light bleeding can be normal after IUD insertion, heavy menstrual bleeding is not typical and should be assessed by a healthcare provider to rule out complications.
Choice D rationale: Advising the client to change her method of birth control without a proper evaluation is not appropriate. A healthcare provider should determine if the IUD is the right method for her or if there are any issues that need to be addressed.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale
Respiratory assessment is vital, especially following childbirth, to ensure the mother is not experiencing respiratory issues.
Choice B rationale
Monitoring hemoglobin levels can help identify significant blood loss during delivery, which can lead to anemia and other complications.
Choice C rationale
A heart rate that is elevated postpartum may indicate underlying issues such as infection or hemorrhage, which need to be reported.
Choice D rationale
Continuous blood trickling from the vagina is a warning sign of potential postpartum hemorrhage, which is a medical emergency.
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