A nurse is assessing a newborn who was exposed to heroin during pregnancy. Which of the following findings should indicate to the nurse that the newborn is experiencing neonatal abstinence syndrome? (Select all that apply.)

High-pitched crying

Tachypneic respirations

Body tremors

Extreme lethargy

Decreased reflexes

Answer and Explanation

Correct Answer : A,B,C

A. High-pitched, excessive crying is a common sign of neonatal abstinence syndrome (NAS).
B. Tachypnea (rapid breathing) is a typical respiratory symptom of NAS.
C. Body tremors and jitteriness are classic signs of withdrawal in newborns.
D. Newborns with NAS typically exhibit hyperactivity, not extreme lethargy.
E. Reflexes are usually increased (hyperactive), not decreased, in NAS.

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Correct Answer is ["C"]

Explanation

A. The car seat should remain rear-facing until at least age 2, or until the child reaches the maximum height and weight limit specified by the manufacturer, not just until 12 months.
B. The retainer (chest) clip should be positioned at the level of the infant's armpits, not the abdomen, to ensure proper restraint.
C. Positioning the car seat at a 45° angle helps keep the infant’s airway open and reduces the risk of aspiration or airway obstruction.
D. For rear-facing seats, the harness straps should be at or below the baby’s shoulders, not above.

A. Lay the tape measure horizontally over the middle of the client's abdomen. B. Place the client in a left-lateral position to obtain the measurement. C. Measure from the upper border of the symphysis pubis to the upper border of the fundus D. Ensure that the client has a full bladder before taking the measurement.

Correct Answer is C

Explanation

A. The tape measure should be placed vertically, not horizontally, over the abdomen to measure fundal height accurately.
B. The client should be in a supine position, not left-lateral, during the measurement.
C. Fundal height is measured from the upper border of the symphysis pubis to the upper border of the uterine fundus.
D. A full bladder can distort the measurement, so the client should have an empty bladder before measuring fundal height.

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A nurse is assessing a newborn who was exposed to heroin during pregnancy. Which of the following findings should indicate to the nurse that the newborn is experiencing neonatal abstinence syndrome? (Select all that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is reviewing the medical record of a client who had a vaginal delivery 3 hr ago. Which of the following findings place the client at risk for postpartum hemorrhage? (Select all that apply.)

Correct Answer is ["C"]

Explanation

A nurse in a clinic is preparing to measure the fundal height of a client who is pregnant. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

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