A nurse has administered vitamin K injection to a newborn.
Which of the following statements by the nurse indicates an understanding of the rationale for this intervention?
“This injection will help prevent your baby from developing a bleeding disorder caused by low vitamin K levels.”
“This injection will help boost your baby’s immune system and protect them from infections.”
“This injection will help stimulate your baby’s liver function and metabolism.”
“This injection will help increase your baby’s appetite and growth.”.
The Correct Answer is A
The correct answer is choice A. This injection will help prevent your baby from developing a bleeding disorder caused by low vitamin K levels.
Vitamin K is essential for the synthesis of clotting factors in the liver.
Newborns have low levels of vitamin K because it does not cross the placenta well and they have limited gut flora to produce it.
Therefore, they are at risk of vitamin K deficiency bleeding (VKDB), which can cause serious and potentially fatal hemorrhages. To prevent VKDB, the American Academy of Pediatrics recommends a single intramuscular dose of 1 mg of vitamin K to all newborn infants within 6 hours of birth.
Choice B is wrong because vitamin K does not boost the immune system or protect from infections.
Choice C is wrong because vitamin K does not stimulate liver function or metabolism.
Choice D is wrong because vitamin K does not increase appetite or growth.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C. Check the medication label for the name, dose, expiry date and route of administration.
This is a standard precaution that should be taken before administering any medication to ensure patient safety and avoid medication errors.
Choice A is wrong because checking the newborn’s blood type and Rh factor is not necessary before giving vitamin K injection.
Vitamin K is not a blood product and does not depend on blood compatibility.
Choice B is wrong because checking the newborn’s bilirubin level and jaundice score is not relevant to vitamin K injection.Vitamin K is given to prevent vitamin K deficiency bleeding (VKDB), which is a serious condition that can cause bleeding in the brain or other organs.
Bilirubin level and jaundice score are indicators of neonatal jaundice, which is a common condition that causes yellowing of the skin and eyes due to excess bilirubin in the blood.
Choice D is wrong because checking the newborn’s weight and length measurements is not required before giving vitamin K injection.The recommended dose of vitamin K for newborns weighing more than 1500 g is 1 mg as a single intramuscular injection within 6 hours of birth.For preterm infants weighing less than 1500 g, the dose is 0.3 mg/kg to 0.5 mg/kg.
The dose does not depend on the exact weight or length of the newborn.
Correct Answer is B
Explanation
The correct answer is choice B. Locate the greater trochanter and the lateral femoral condyle and use the middle third of this line.This technique ensures proper needle placement in the vastus lateralis muscle, which is the preferred site for vitamin K injection in newborns.Vitamin K is given to prevent vitamin K deficiency bleeding (VKDB), which can cause serious bleeding problems in newborns.
Choice A is wrong because dividing the thigh into thirds horizontally and vertically and using the outer middle third of the thigh is a technique for locating the dorsogluteal site, which is not recommended for newborns.
Choice C is wrong because palpating the anterior iliac spine and the mid-patella and using the lateral aspect of this line is a technique for locating the rectus femoris site, which is an alternative site for vitamin K injection in newborns but not as preferred as the vastus lateralis site.
Choice D is wrong because identifying the midpoint of a line drawn from the anterior superior iliac spine to the pubic tubercle and using this point is a technique for locating the ventrogluteal site, which is not recommended for newborns.
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