A nurse is assisting the parent of a preterm newborn to perform skin-to-skin care to enhance parental bonding. Which of the following actions should the nurse take?
Instruct the parent to remove his shirt.
Place the newborn and parent in a private room that is brightly lit.
Place the newborn in a horizontal position in the parent's arms.
Completely undress the newborn.
The Correct Answer is A
Choice A rationale:
Instructing the parent to remove their shirt allows for direct skin-to- skin contact between the parent's chest and the preterm newborn, which is commonly known as kangaroo care. This technique promotes bonding, warmth, and comfort for both the parent and the newborn.
Choice B rationale:
Placing the newborn and parent in a private room that is brightly lit might not be optimal for skin-to-skin care, as preterm newborns are sensitive to light and sound. A calm and dimly lit environment is preferred.
Choice C rationale:
Placing the newborn in a horizontal position in the parent's arms is appropriate, as it allows for skin-to-skin contact and facilitates bonding. The newborn's head is positioned near the parent's chest to listen to the heartbeat.
Choice D rationale:
Completely undressing the newborn is not necessary for skin-to-skin care and may cause discomfort to the newborn. Keeping the newborn dressed in a diaper is sufficient.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale:
The sodium level of 140 mEq/L is within the normal range for children, which is 135 to 145 mEq/L. Sodium levels may be low in nephrotic syndrome due to fluid retention and dilutional hyponatremia, but this is not the case for this child.
Choice B rationale:
The platelet count of 350,000/mm3 is within the normal range for children, which is 150,000 to 450,000/mm3. Platelet levels may be elevated in nephrotic syndrome due to increased production by the bone marrow in response to inflammation and infection, but this is not the case for this child.
Choice C rationale:
The nurse should report the protein level of 2 g/dL to the provider, as this is abnormally low and indicates severe proteinuria. Proteinuria is a hallmark of nephrotic syndrome, as the glomeruli become damaged and allow protein to leak into the urine. Normal protein levels for children are 6 to 8 g/dL. Low protein levels can lead to edema, hypoalbuminemia, and hyperlipidemia.
Choice D rationale:
The cholesterol level of 170 mg/dL is within the normal range for children, which is less than 200 mg/dL. Cholesterol levels may be high in nephrotic syndrome due to increased synthesis by the liver as a compensatory mechanism for low protein levels, but this is not the case for this child.
Correct Answer is B
Explanation
Choice A rationale:
A 7-month-old infant with Down syndrome is less likely to use a spoon.
Choice B rationale:
Crawling short distances is a developmental milestone that can be expected at this age.
Choice C rationale:
Speaking five to eight words is not an appropriate milestone for a 7-month-old infant.
Choice D rationale:
Standing with assistance usually occurs around 9-12 months, which might be delayed in infants with Down syndrome.
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