A nurse is caring for a newborn immediately following birth and notes a large amount of mucus in the newborn's mouth and nose. Identify the sequence the nurse should follow when performing suction with a bulb syringe.

(Arrange the steps, placing them in the selected order of performance. Use all the steps.)

Compress the bulb syringe.

Place the bulb syringe in the newborn's mouth.

Assess the newborn for reﬂex bradycardia.

Use the bulb syringe to suction the newborns nose.

Answer and Explanation

The Correct Answer is A, B, D, C

Compressing the bulb syringe before placing it in the newborn's mouth or nose creates a vacuum that allows the suctioning of the mucus¹².
Placing the bulb syringe in the newborn's mouth first helps clear the oral airway and prevent aspiration of mucus into the lungs¹². The nozzle of the bulb syringe should be gently inserted into the corner of the mouth, not the center, to avoid stimulating the gag reﬂex¹².
Using the bulb syringe to suction the newborns nose helps clear the nasal airway and improve breathing¹². The nozzle of the bulb syringe should be gently inserted into one nostril at a time, and not too far, to avoid injuring the nasal mucosa¹².
Assessing the newborn for reﬂex bradycardia helps monitor for any adverse eﬀects of suctioning, such as a decrease in heart rate due to vagal stimulation¹³. Reﬂex bradycardia can cause hypoxia and acidosis in newborns, and may require oxygen administration or resuscitation³. The normal heart rate for a newborn is 120 to 160 beats per minute³.

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Correct Answer is D

Explanation

Preparing a toddler for a new sibling can be challenging, but there are some strategies that can help ease the transition and reduce the risk of jealousy or resentment. One of these strategies is to make any major changes in the toddler's routine or environment well before the baby arrives, such as moving to a new bed, starting preschool, or toilet training. This can help the toddler adjust to the change without feeling displaced or threatened by the baby. It can also prevent the toddler from associating the change with the baby and blaming the baby for it¹².

Moving a toddler to a new bed 2 months before the baby comes home is a good example of this strategy. It gives the toddler enough time to get used to sleeping in a diﬀerent place and feeling comfortable and secure in it. It also avoids making the toddler feel like they are being kicked out of their bed to make room for the baby. The toddler may even feel proud of having a big-kid bed and being more independent¹².

The other options are not appropriate responses by the nurse because they may have negative eﬀects on the toddler's adjustment to the new sibling:

a) "Let your toddler see you carrying the baby into the home for the first time." This is not a good idea because it may make the toddler feel left out or replaced by the baby. The toddler may not understand why they were not with you when you brought the baby home and may feel hurt or angry. A better option is to have someone else carry the baby into the home while you greet your toddler with a hug and a smile. Then, you can introduce your toddler to their new sibling and involve them in welcoming and caring for the baby¹³.

b) "Avoid bringing your toddler to prenatal visits." This is not a good idea because it may make the toddler feel excluded or curious about what is going on. Bringing your toddler to some of your prenatal visits can help them learn more about the baby and feel more connected to them. You can show your toddler pictures of the baby's development, let them hear the baby's heartbeat, or ask them to help you choose clothes or toys for the baby. However, you should also be prepared for your toddler's possible boredom or impatience during long or boring appointments and bring some snacks or activities to keep them entertained¹⁴.

c) "Require scheduled interactions between the toddler and the baby." This is not a good idea because it may make the toddler feel pressured or resentful toward the baby. Forcing your toddler to interact with the baby when they are not ready or interested can backfire and cause more conﬂict or distance between them. A better option is to follow your toddler's cues and let them decide how much and when they want to interact with the baby. You can also praise your toddler for any positive interactions they have with the baby, such as giving them a gentle kiss, sharing a toy, or singing a song¹³.

A. Place the client in the Trendelenburg position. B. Conduct a vaginal exam. C. Collect a specimen for an indirect Coombs test. D. Perform vibroacoustic stimulation.

Correct Answer is D

Explanation

A nonstress test (NST) is a common procedure used to assess the well-being of the fetus. During an NST, the fetal heart rate is monitored for a period of time to evaluate its response to fetal movement. In a normal NST, the fetal heart rate should show accelerations (temporary increases in heart rate) with fetal movement. Lack of accelerations can indicate fetal compromise or a non-reactive test.

In the given scenario, the absence of accelerations for 20 minutes indicates a non-reactive NST. In such cases, further interventions may be required to stimulate the fetus and provoke a response. Vibroacoustic stimulation is a non-invasive method that involves using sound or vibration to stimulate the fetus and elicit a fetal heart rate acceleration. It can be performed by placing a device on the mother's abdomen and delivering a brief sound or vibration near the fetal head.

Option a) Placing the client in the Trendelenburg position is not appropriate in this situation. The Trendelenburg position involves placing the client's head lower than the feet, and it is not indicated for a non-reactive NST.

Option b) Conducting a vaginal exam is not necessary in this scenario. The non-reactive NST indicates a lack of fetal heart rate accelerations, and a vaginal exam would not provide additional information or help in this situation.

Option c) Collecting a specimen for an indirect Coombs test is unrelated to the non-reactive NST. An indirect Coombs test is used to detect antibodies in the mother's blood that could potentially cause hemolytic disease of the newborn. It is not indicated as a response to a non-reactive NST.

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Naxlex Comprehensive Predictor Exams

A nurse in a clinic is caring for a client who is in her second trimester of pregnancy. The client expresses concern about preparing her 2-year-old child for a new sibling. Which of the following is an appropriate response by the nurse?

Correct Answer is D

Explanation

A nurse is performing a nonstress test on a client who is at 35 weeks of gestation and has diabetes mellitus. The test reveals no accelerations of fetal heart rate for 20 minutes. Which of the following actions should the nurse take?

Correct Answer is D

Explanation

A nurse manager in a newborn nursery is reviewing infection control procedures with a group of newly hired nurses. Which of the following instructions should the nurse manager include in the teaching?

A nurse is caring for a client who is at 8 weeks of gestation and has an ectopic pregnancy. Which of the following manifestations should the nurse expect?

A nurse is admitting a client who is in active labor and has had two prior cesarean births. The nurse should identify that the client is at an increased risk for which of the following complications?

A nurse is assessing a full-term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider?

A nurse is admitting a client to the birthing unit who reports her contractions started 1 hr. ago. The nurse determines the client is 80% eﬀaced and 8 cm dilated. The nurse realizes that the client is at risk for which of the following conditions?

A nurse is assessing a newborn whose mother had gestational diabetes mellitus. The nurse should monitor for which of the following findings as a manifestation of hypoglycemia?

A nurse in a provider's office is caring for a 20-year-old client who is at 12 weeks of gestation and requests an amniocentesis to determine the sex of the fetus. Which of the following responses should the nurse make?

A nurse is reviewing the laboratory report for a client who is in active labor. The client tested positive for Group B Streptococcus β-hemolytic. Which of the following medications should the nurse plan to administer to the client?