A newborn has meconium aspiration at birth. The nurse notes increasing respiratory distress. What action takes priority?
Obtain an oxygen saturation.
Stimulate the baby to increase respirations.
Prepare to initiate ECMO.
Notify the provider at once.
The Correct Answer is D
Choice A) Obtain an oxygen saturation: This is not a priority action because it does not address the underlying cause of the respiratory distress, which is meconium aspiration. Meconium aspiration can cause airway obstruction, inflammation, infection, and pulmonary hypertension in the newborn. Oxygen saturation may be low, but it is not a reliable indicator of the severity of the condition.
Choice B) Stimulate the baby to increase respirations: This is not a priority action because it may worsen the respiratory distress by increasing the work of breathing and causing more meconium to be aspirated. Stimulation may also cause stress and hypoxia in the newborn.
Choice C) Prepare to initiate ECMO: This is not a priority action because it is a last resort treatment for severe cases of meconium aspiration syndrome that do not respond to conventional therapies. ECMO stands for extracorporeal membrane oxygenation, which is a form of life support that bypasses the lungs and provides oxygen to the blood.
ECMO has many risks and complications, such as bleeding, infection, and organ damage. It should only be used when other options have failed and with the consent of the parents.
Choice D) Notify the provider at once: This is the correct action because it allows for prompt assessment and intervention by the provider, who can initiate appropriate treatments for meconium aspiration syndrome. These may include suctioning of the airway, administration of antibiotics, surfactant, or inhaled nitric oxide, and mechanical ventilation . Early treatment can improve the outcomes and reduce the complications of meconium aspiration syndrome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A) Increased urinary output: This is not a sign of sepsis in newborns. In fact, sepsis can cause reduced urinary output due to poor blood flow to the kidneys and dehydration.
Choice B) Hypothermia: This is a sign of sepsis in newborns. Sepsis can cause changes in temperature, often fever, but sometimes low temperature. Hypothermia can indicate a severe infection that affects the body's ability to regulate its temperature.
Choice C) Wakefulness: This is not a sign of sepsis in newborns. Sepsis can cause reduced activity and lethargy due to inflammation and organ dysfunction.
Choice D) Interest in feeding: This is not a sign of sepsis in newborns. Sepsis can cause reduced sucking and difficulty feeding due to poor appetite, nausea, vomiting, and abdominal distension.
Correct Answer is C
Explanation
Choice A) Newborns are abdominal breathers is incorrect because this is not a reason why the respiratory rate should be counted for a complete minute, but rather a characteristic of how newborns breathe. Abdominal breathing means that the diaphragm and the abdominal muscles are the main muscles used for breathing, rather than the chest muscles. Newborns are abdominal breathers because their chest wall is more compliant and less stable than adults, and their intercostal muscles are not fully developed. Abdominal breathing does not affect the accuracy or duration of measuring the respiratory rate, as long as the abdomen is visible and palpable. Therefore, this response is irrelevant and inaccurate.
Choice B) Activity will increase the respiratory rate is incorrect because this is not a reason why the respiratory rate should be counted for a complete minute, but rather a factor that can influence the respiratory rate. Activity means any physical or mental exertion that requires more oxygen and energy from the body. Activity can increase the respiratory rate, as well as the heart rate and blood pressure, to meet the increased oxygen demand and carbon dioxide removal. However, activity does not affect the accuracy or duration of measuring the respiratory rate, as long as the newborn is calm and resting during the measurement. Therefore, this response is irrelevant and inaccurate.
Choice C) The rate and rhythm of breath are irregular in newborns is correct because this is a reason why the respiratory rate should be counted for a complete minute. The rate and rhythm of breath refer to how fast and how regularly one breathes. Newborns have an irregular rate and rhythm of breath, which means that they breathe at different speeds and intervals, sometimes pausing for a few seconds between breaths. This is normal and harmless for newborns, as long as they do not stop breathing for more than 20 seconds or show signs of distress. However, it can make it difficult to measure the respiratory rate accurately, as counting for a shorter period may not reflect the true average rate. Therefore, counting for a complete minute can ensure a more reliable measurement. Therefore, this response is clear and accurate.
Choice D) Newborns do not expand their lungs fully with each respiration is incorrect because this is not a reason why the respiratory rate should be counted for a complete minute, but rather a feature of how newborns breathe.
Lung expansion means how much air one inhales and exhales with each breath. Newborns do not expand their lungs fully with each respiration, because they have smaller lung volumes and capacities than adults, and they breathe more shallowly and rapidly. However, lung expansion does not affect the accuracy or duration of measuring the respiratory rate, as long as the chest or abdomen movement is visible and palpable. Therefore, this response is irrelevant and inaccurate.
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