A nurse is caring for a newborn.
Drag words from the choices below to fill in each blank in the following sentence.
The client is at risk for developing
The Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}
The client is at risk for developing transient tachypnea of the newborn and hypoglycemia.
Rationale:
Target 1: Transient Tachypnea of the Newborn (TTN): The newborn has progressively increasing respiratory rates (68 → 72 → 76 breaths/min) along with grunting and mild intercostal retractions. Cesarean birth is a major risk factor for TTN because the absence of labor contractions delays the clearance of fetal lung fluid. TTN typically presents within the first few hours of life with tachypnea and mild respiratory distress, resolving within 24–72 hours.
Target 2: Hypoglycemia: The newborn weighs 4200 g (9 lb 4 oz), indicating macrosomia.
Large-for-gestational-age (LGA) infants are at higher risk for hypoglycemia due to increased insulin production in response to maternal hyperglycemia. Tachypnea can also be a sign of hypoglycemia in neonates.
Incorrect Options:
Tachycardia: The newborn’s heart rate is elevated (154–156 bpm), but mild tachycardia is expected in newborns and is not the primary concern compared to respiratory distress and hypoglycemia risk.
Bronchopulmonary Dysplasia (BPD): BPD is a chronic lung condition primarily seen in preterm infants who require prolonged mechanical ventilation and oxygen therapy. This newborn was term, had clear amniotic fluid, and no intubation, making BPD unlikely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Contractions could indicate preterm labor, a potential complication of amniocentesis. The nurse should monitor for uterine activity.
B. Hypertension is not a common complication of amniocentesis.
C. Epigastric pain is more associated with preeclampsia, not amniocentesis.
D. Vomiting is not a common complication of amniocentesis.
Correct Answer is A
Explanation
A. Medication reconciliation ensures that the client’s home medications are accurately compared to new prescriptions to avoid errors.
B. Adverse effects should be monitored but are not part of reconciliation.
C. Nutritional supplements must be included, as they can interact with prescribed medications.
D. The nurse should document the list immediately rather than waiting for the client to do it later.
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