A nurse is assessing a term newborn who is 48 hours old.

The mother has a history of opioid use during pregnancy and was prescribed methadone.

Based on the findings 24 hours later, how should the nurse interpret the findings?

Transient strabismus

Mottling

Respiratory rate of 70/min

Loose stools

Regurgitation

Answer and Explanation

The Correct Answer is C

Choice A rationale
Transient strabismus, or temporary misalignment of the eyes, is not typically a symptom observed in newborns exposed to opioids during pregnancy.
Choice B rationale
Mottling, or patchy skin color, is a common physical characteristic in newborns and is not specifically associated with opioid exposure during pregnancy.
Choice C rationale
A respiratory rate of 70/min is significantly higher than the normal range for a newborn, which is typically between 30 and 60 breaths per minute. This could be a sign of neonatal abstinence syndrome (NAS), a group of conditions caused by withdrawal from certain drugs that the newborn was exposed to in the womb.
Choice D rationale
Loose stools are not typically associated with opioid exposure during pregnancy.
Choice E rationale
Regurgitation, or spitting up, is common in newborns and is not specifically associated with opioid exposure during pregnancy.

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Correct Answer is B

Explanation

Choice A rationale
Chills are not a common side effect of clomiphene citrate.
Choice B rationale
Breast tenderness is a common side effect of clomiphene citrate. This is due to the hormonal changes induced by the medication.
Choice C rationale
Tinnitus, or ringing in the ears, is not a common side effect of clomiphene citrate.
Choice D rationale
Urinary frequency is not a common side effect of clomiphene citrate.

A. Maintain a low stimulation environment B. Weigh the newborn daily C. Advise the parent to avoid breastfeeding D. Avoid eye contact with the newborn during feeding E. Plan to administer naloxone F. Swaddle the newborn with flexed extremities G. Perform Ballard newborn screening each shift . .

Correct Answer is ["A","B","F"]

Explanation

Choice A rationale
Maintaining a low-stimulation environment is recommended for newborns exhibiting clinical findings of NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice B rationale
Weighing the newborn daily is important in the care of a newborn with NAS56. This can help to monitor the newborn’s growth and development, and any significant changes in weight could indicate a need for further medical intervention.
Choice C rationale
Advising the parent to avoid breastfeeding is not typically recommended for mothers who used opioids prior to pregnancy and were prescribed methadone during pregnancy. In fact, breastfeeding is often encouraged for these mothers, as it can help to reduce the severity of NAS symptoms in the newborn.
Choice D rationale
Avoiding eye contact with the newborn during feeding is not typically recommended as part of the care for a newborn with NAS56. Eye contact can help to promote bonding between the parent and the newborn.
Choice E rationale
The administration of naloxone is not typically recommended for a newborn with NAS56. Naloxone is a medication used to reverse the effects of opioids, but it is not typically used in the treatment of NAS56.
Choice F rationale
Swaddling the newborn with flexed extremities can help to comfort a newborn with NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice G rationale
This option is not typically necessary for the management of neonatal abstinence syndrome (NAS). The Ballard score is used to assess gestational age and physical maturity of a newborn, but it is not a routine part of monitoring for NAS.

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A nurse is assessing a term newborn who is 48 hours old. The mother has a history of opioid use during pregnancy and was prescribed methadone. Based on the findings 24 hours later, how should the nurse interpret the findings?

Nursing Test Bank

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A nurse is teaching a client who is experiencing infertility about clomiphene citrate. Which adverse effects should the nurse include?

Correct Answer is B

Explanation

Correct Answer is ["A","B","F"]

Explanation

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A nurse is assessing a term newborn who is 48 hours old.

The mother has a history of opioid use during pregnancy and was prescribed methadone.

Based on the findings 24 hours later, how should the nurse interpret the findings?