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.

Assess the newborn for reflex bradycardia.

Compress the bulb syringe.

Use the bulb syringe to suction the newborn's nose.

Place the bulb syringe in the newborn's mouth.

Answer and Explanation

The Correct Answer is B,D,C,A

The correct answer is choice B, D, C, A. B. Compress the bulb syringe: The nurse should first compress the bulb syringe to expel air from it. This ensures that when it is placed in the newborn’s mouth or nose, it can create suction to effectively remove mucus. D. Place the bulb syringe in the newborn's mouth: The nurse should then place the compressed bulb syringe into the newborn’s mouth first, as clearing the mouth is essential before the nose to prevent aspiration. C. Use the bulb syringe to suction the newborn's nose: After suctioning the mouth, the nurse should use the bulb syringe to suction the nose. Suctioning the nose after the mouth helps to clear the airway more effectively and reduce the risk of mucus being aspirated into the lungs. A. Assess the newborn for reflex bradycardia: After suctioning, the nurse should assess the newborn for any signs of reflex bradycardia, which can occur due to vagal stimulation during suctioning. This ensures the newborn's heart rate and overall well-being are monitored.

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Correct Answer is C

Explanation

Fetal bradycardia. A pudendal nerve block is a type of regional anesthesia used during childbirth to relieve pain. It involves injecting a local anesthetic into the pudendal nerve. Fetal bradycardia is a potential adverse effect of this type of anesthesia. It occurs when the fetal heart rate drops below 110 beats per minute.

A. Monitor the rectal temperature every 4 hr. B. Administer broad-spectrum antibiotics. C. Cleanse the site with povidone-iodine. D. Prepare for surgical closure after 72 hr

Correct Answer is B

Explanation

A. Monitor the rectal temperature every 4 hr: Rectal temperature measurement is contraindicated in this newborn due to the risk of trauma to the spinal cord or irritation of the leaking sac. Axillary temperature monitoring is a safer alternative.

B. Administer broad-spectrum antibiotics: Broad-spectrum antibiotics help prevent infection from organisms entering through the exposed or leaking sac. This is a priority intervention to ensure the safety of the newborn.

C. Cleanse the site with povidone-iodine: Povidone-iodine is not recommended for cleansing the sac, as it can cause irritation or toxicity. Instead, the sac should be kept clean and moist with a sterile, saline-soaked dressing.

D. Prepare for surgical closure after 72 hr: Surgical closure of the defect is typically performed within 24 to 48 hours after birth to minimize infection risk and prevent further damage to neural tissue. Waiting beyond this window is not standard practice for a leaking myelomeningocele.

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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.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who has had a pudendal nerve block. The nurse should monitor for which of the following findings as an adverse effect?

Correct Answer is C

Explanation

A nurse is planning care immediately following birth for a newborn who has a myelomeningocele that is leaking cerebrospinal fluid. Which of the following actions should the nurse include in the plan of care?

Correct Answer is B

Explanation

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