A nurse is caring for a neonate who has a myelomeningocele and is admitted to the newborn intensive care unit (NICU) awaiting surgery. Which of the following nursing goals has the highest priority in the care of this infant?

Provide age-appropriate stimulation.

Educate the parents about the defect.

Promote maternal-infant bonding.

Maintain integrity of the sac.

Answer and Explanation

The Correct Answer is D

A. While stimulation is important, the priority in this case is ensuring the infant’s safety and preventing further injury to the defect.

B. Education is vital but secondary to the immediate physical care needs of the infant.

C. Promoting bonding is important but does not take precedence over maintaining the integrity of the sac.

D. Maintaining the integrity of the sac is the highest priority to prevent infection and further neurological damage.

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Correct Answer is D

Explanation

A. Polyuria is more commonly seen in hyperglycemia, not hypoglycemia, so it is unlikely to be present with a blood glucose level of 55 mg/dL.

B. Dry, flushed skin is typically a sign of hyperglycemia (e.g., in diabetic ketoacidosis), not hypoglycemia.

C. Deep, rapid respirations are a symptom of metabolic acidosis or severe hyperglycemia, not hypoglycemia.

D. Tachycardia is a common compensatory response to hypoglycemia, as the body tries to increase glucose delivery to tissues.

Correct Answer is ["5.3"]

Explanation

Rationale:

Convert pounds to kilograms: 28 lb / 2.2 = 12.7 kg (rounded to the nearest tenth)

Calculate the required dose: 12.7 kg * 10 mg/kg = 127 mg

Calculate the volume to administer: (127 mg / 120 mg) * 5 mL = 5.3 mL (rounded to the nearest tenth).

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A nurse is caring for a neonate who has a myelomeningocele and is admitted to the newborn intensive care unit (NICU) awaiting surgery. Which of the following nursing goals has the highest priority in the care of this infant?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Correct Answer is D

Explanation

A nurse is preparing to administer acetaminophen 10 mg/kg/dose to a child who weighs 28 lb. The amount available is acetaminophen 120 mg/5 mL. How many mL should the nurse administer? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

Correct Answer is ["5.3"]

Explanation

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