A newborn is diagnosed with hypoglycemia.
Which intervention should the nurse prioritize?
Administering IV insulin.
Encouraging frequent breastfeeding.
Monitoring blood pressure.
Administering a hypertonic saline solution.
The Correct Answer is B
Encouraging frequent breastfeeding.
This is because breastfeeding provides glucose to the newborn baby, which can help prevent or treat hypoglycemia (low blood sugar). Hypoglycemia can cause problems such as shakiness, blue tint to the skin, and breathing and feeding problems.
Choice A is wrong because administering IV insulin would lower the blood sugar level even more, which could be dangerous for the baby.
Choice C is wrong because monitoring blood pressure is not directly related to hypoglycemia.
Blood pressure may be affected by other factors such as stress, infection, or dehydration.
Choice D is wrong because administering a hypertonic saline solution would increase the sodium level in the blood, which could cause dehydration and electrolyte imbalance.
A hypertonic saline solution is not a source of glucose for the baby.
Normal ranges for blood glucose levels in newborns are between 47 to 85 mg/dL. Hypoglycemia is defined as blood glucose below 47 mg/dL.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
These are normal inflammatory responses to the vaccine.
The tetanus vaccine protects people from the bacteria that cause tetanus, a serious disease that causes muscle stiffness and spasms.
The vaccine stimulates the body’s immune system to produce antibodies against the bacteria.Sometimes, this immune response can cause mild symptoms such as pain, redness, swelling, fever, headache, or tiredness.
These are not signs of an infection or an allergic reaction, but rather the body’s way of building immunity.
Choice A is wrong because an allergic reaction to the vaccine would cause more severe symptoms such as hives, swelling of the face or throat, difficulty breathing, or shock.
These symptoms would usually occur within minutes or hours of getting the vaccine and require immediate medical attention.
Choice C is wrong because these are not signs of an active infection with tetanus.
Tetanus is a rare but potentially fatal disease that causes muscle spasms and paralysis.
It is caused by bacteria that enter the body through wounds or cuts.The symptoms of tetanus usually appear several days or weeks after exposure and include lockjaw, stiffness of the neck and abdomen, difficulty swallowing, fever, sweating, and seizures.
The tetanus vaccine prevents the disease by creating immunity before exposure.
Choice D is wrong because these are not adverse effects of preservatives in the vaccine.
Preservatives are substances that prevent contamination and spoilage of vaccines.The most common preservative used in tetanus vaccines is thimerosal, a mercury-based compound that has been proven to be safe and effective.
There is no evidence that thimerosal causes autism or any other health problems.
Some people may have a sensitivity to thimerosal or other ingredients in the vaccine, but this is very rare and would cause an allergic reaction as described in choice A.
Correct Answer is C
Explanation
Reticulocyte count 2%.
A reticulocyte count measures the percentage of immature red blood cells (RBCs) in the blood.A low reticulocyte count indicates that the bone marrow is not producing enough RBCs, which is a characteristic feature of anemia of prematurity (AOP).A normal reticulocyte count for preterm infants is 3-6%.
Choice A is wrong because hemoglobin 10 g/dL is within the normal range for preterm infants.
Hemoglobin is the protein in RBCs that carries oxygen.
A low hemoglobin level indicates anemia.
Choice B is wrong because hematocrit 30% is within the normal range for preterm infants.
Hematocrit is the percentage of blood volume that is occupied by RBCs.
A low hematocrit level indicates anemia.
Choice D is wrong because platelet count 150,000/mm3 is within the normal range for preterm infants.
Platelets are cell fragments that help with blood clotting.
A low platelet count indicates thrombocytopenia, which is a different condition from anemia.
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