A nurse in a newborn nursery is organizing a plan of care for four newborns after receiving a change-of-shift report. Which of the following assessments should the nurse perform first?

Check the blood glucose level of a newborn who is 4 hr old and jittery.

Conduct a universal newborn screening on a newborn who is 26 hr old.

Conduct a New Ballard Score for a newborn who is 12 hr old.

Check the temperature of a newborn who is 2 hr old prior to the first bath.

Answer and Explanation

The Correct Answer is A

A. A jittery newborn at 4 hours old may be experiencing hypoglycemia, which is a potentially serious condition requiring immediate assessment and intervention.
B. Universal newborn screening is important but can be delayed until the newborn is more stable.
C. The New Ballard Score is an assessment of gestational age and can be done after stabilization.
D. Checking temperature prior to the first bath is important but less urgent than evaluating possible hypoglycemia.

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Correct Answer is D

Explanation

A. Breastfeeding is not contraindicated in mothers with hepatitis B if the newborn receives appropriate prophylaxis.
B. Airborne precautions are not necessary; hepatitis B is transmitted through blood and body fluids, not airborne droplets.
C. Bathing the newborn does not affect hepatitis B transmission risk and does not need to be delayed.
D. Administering hepatitis B immune globulin (HBIG) IM to the newborn within 12 hours of birth, along with the first dose of the hepatitis B vaccine, is essential to prevent vertical transmission of hepatitis B virus.

A. Assess for cervical dilation. B. Obtain a vaginal swab to test for ferning C. Administer oxytocin IV every hour D. Monitor fetal heart rate tracings

Correct Answer is D

Explanation

A. Assessing cervical dilation is contraindicated due to risk of worsening bleeding with abruptio placenta.
B. Vaginal swabs for ferning test are used to assess rupture of membranes, not abruptio placenta.
C. Administering oxytocin can increase uterine contractions and worsen placental separation, so it is contraindicated.
D. Monitoring fetal heart rate tracings is essential to assess fetal well-being in cases of abruptio placenta.

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A nurse in a newborn nursery is organizing a plan of care for four newborns after receiving a change-of-shift report. Which of the following assessments should the nurse perform first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing the plan of care for a term newborn who was asymptomatic at birth and whose mother had hepatitis B during pregnancy. Which of the following interventions should the nurse include in the plan of care?

Correct Answer is D

Explanation

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Correct Answer is D

Explanation

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