A nurse is caring for a 37 weeks 4 days newborn admitted to the Neonatal Intensive Care Unit (NICU) today who is at risk for Neonatal Abstinence Syndrome (NAS) due to maternal substance use during pregnancy.
Which medication and plan of care might the nurse anticipate for this newborn with severe NAS symptoms?
Medication: Morphine and Plan of Care: Decrease environmental stimulation.
Medication: Phenobarbital and Plan of Care: Delay feeding until symptoms subside.
Medication: Amoxicillin and Plan of Care: Place the infant on the abdomen to relieve congestion.
Medication: Ibuprofen and Plan of Care: Apply barrier cream with each diaper change.
The Correct Answer is A
Choice A rationale
Morphine is a common first-line opioid used to manage severe symptoms of NAS, such as tremors, seizures, and autonomic dysfunction, by targeting the same opioid receptors affected by maternal substance use. A decreased environmental stimulation plan of care, including swaddling, quiet, dark spaces, and gentle handling, is vital to minimize CNS irritability and hyperactivity often seen in NAS, promoting neurobehavioral organization and reducing energy expenditure.
Choice B rationale
Phenobarbital, an anticonvulsant and sedative, is often used as a second-line or adjunct therapy for NAS, particularly when seizures are present or if the infant is non-responsive to the primary opioid. Delaying feeding is inappropriate; infants with NAS often have poor suck/swallow coordination and increased caloric needs due to hyperactivity and may require small, frequent feedings or high-calorie formulas to prevent dehydration and ensure adequate growth.
Choice C rationale
Amoxicillin is an antibiotic used to treat bacterial infections and has no role in the pharmacological management of Neonatal Abstinence Syndrome (NAS), which is a neurobehavioral condition caused by in utero exposure to opioids or other substances. Placing the infant on the abdomen is a maneuver sometimes used to relieve respiratory distress or congestion but is not a primary or specific intervention for the CNS irritability and hypertonia characteristic of NAS.
Choice D rationale
Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) used for pain and fever relief and is not indicated for the management of the complex neurobehavioral and autonomic symptoms of NAS. Applying barrier cream is routine skin care for all neonates to prevent diaper rash; while helpful for the diarrhea associated with NAS, it is not the most specific or critical component of the overall plan of care for severe symptoms. —.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Vitamin K is a fat-soluble vitamin essential for synthesizing coagulation factors in the liver, specifically factors II, VII, IX, and X, thereby preventing bleeding. Its primary function is in hemostasis, not digestion or nutrient absorption. Digestion of fats relies on bile salts and lipase, while nutrient absorption primarily occurs across the intestinal wall epithelia.
Choice B rationale
Vitamin K is routinely administered to newborns to prevent Vitamin K Deficiency Bleeding (VKDB), which can present as severe and potentially life-threatening hemorrhage, particularly within the skull (intracranial hemorrhage). Newborns have low stores of Vitamin K at birth and lack the gut flora necessary for endogenous synthesis, making supplementation critical to support clotting factor production.
Choice C rationale
While Vitamin K is standard prophylactic care for all newborns to prevent bleeding disorders, its administration is not mandated by all state laws exclusively for preterm infants. It is universally recommended for all newborns, regardless of gestational age, due to their physiologically low levels of circulating clotting factors and impaired synthesis.
Choice D rationale
The rationale for Vitamin K administration is to prevent systemic bleeding due to low coagulation factor levels; it is a vital intervention for all newborns. While it does support the coagulation needed to prevent excessive bleeding during circumcision, its benefit extends to preventing spontaneous hemorrhages in all infants, regardless of sex or planned procedures. —.
Correct Answer is C
Explanation
Choice A rationale
The patient's presentation of sudden shortness of breath and chest pain, especially with tachycardia (HR: 119), recent cesarean section, obesity (BMI of 35), and minimal ambulation (risk factors for venous thromboembolism, VTE), strongly suggests a potential Pulmonary Embolism (PE). Administering an opioid like hydrocodone for pain could mask symptoms or depress respiratory drive, delaying the necessary critical intervention.
Choice B rationale
Given the acute onset of dyspnea and chest pain in a high-risk postpartum patient, documenting the findings and continuing routine care is an unsafe and inappropriate action. These symptoms are signs of a potentially life-threatening condition, such as a PE or Myocardial Infarction (MI), requiring immediate, focused respiratory and cardiovascular assessment and rapid medical evaluation.
Choice C rationale
The symptoms—sudden shortness of breath, chest pain, and tachycardia in a high-risk (obese, post-surgical, minimal ambulation) postpartum patient—are classic indicators of a PE. The most appropriate immediate nursing action is to stabilize the patient with supplemental oxygen, conduct a focused assessment (lung sounds, oxygen saturation), and notify the healthcare provider immediately to prepare for diagnostic tests like a CT pulmonary angiography (CTPA) or a V/Q scan.
Choice D rationale
While deep breathing exercises are beneficial post-surgery, they are insufficient as the primary intervention for a suspected PE. Encouraging rest may decrease oxygen demand, but the priority must be prompt medical diagnosis and treatment for the underlying likely pathology of a clot obstructing pulmonary blood flow. This situation necessitates urgent diagnostic workup, not just comfort measures.
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