A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following actions should the nurse take?

Swaddle the newborn with his legs extended.

Schedule larger volume feedings at less frequent intervals.

Maintain eye contact with the newborn during feedings.

Plan care to minimize handling of the newborn.

Answer and Explanation

The Correct Answer is D

Choice A rationale:
Swaddling the newborn with his legs extended is not the appropriate action for a newborn with neonatal abstinence syndrome (NAS). NAS occurs when a baby is born dependent on drugs, usually because the mother used opioids during pregnancy. Swaddling may provide some comfort, but extending the legs could increase discomfort and agitation.

Choice B rationale:
Scheduling larger volume feedings at less frequent intervals is not the correct approach for a newborn with NAS. These infants often have feeding difficulties and may require smaller, more frequent feedings to reduce the risk of aspiration.

Choice C rationale:
Maintaining eye contact with the newborn during feedings may not be well-tolerated by a baby with NAS. They can be irritable and easily overstimulated, and eye contact during feeding may exacerbate their agitation.

Choice D rationale:
Planning care to minimize handling of the newborn is the most appropriate action for a baby with NAS. These infants are sensitive to stimuli and can become agitated easily, so minimizing unnecessary handling helps reduce their distress.

The correct answer is D. Plan care to minimize handling of the newborn.

Here's why:

Swaddling with legs extended: This is not recommended as it can be uncomfortable for the newborn and may exacerbate withdrawal symptoms.
Larger volume feedings at less frequent intervals: This can be difficult for newborns with NAS due to their increased metabolic rate and may lead to overfeeding.
Maintaining eye contact during feedings: While this is important for bonding, it can be overwhelming for newborns with NAS, who often prefer a calm environment.

Minimizing handling is a key intervention in caring for newborns with NAS. Excessive handling can trigger withdrawal symptoms and make the newborn more irritable. Instead, focus on gentle, soothing techniques like swaddling with arms tucked in, rocking, and providing a quiet, dimly lit environment.

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Correct Answer is C

Explanation

Choice A rationale:

The nurse should not advise the client to "Move your toddler to his new bed 2 months before the baby comes home.”. This can disrupt the toddler's routine and create unnecessary stress during a significant transition in their life.

Choice B rationale:

It is not appropriate to "Avoid bringing your toddler to prenatal visits.”. Involving the toddler in prenatal visits can help them adjust to the idea of a new sibling and reduce potential jealousy or feelings of being excluded.

Choice C rationale:

The correct answer is to "Let your toddler see you carrying the baby into the home for the first time.”. This approach allows the toddler to witness the arrival of the new sibling and can help them feel involved and excited about the new addition to the family.

Choice D rationale:

"Require scheduled interactions between the toddler and the baby”. is not the best response. While it's essential to facilitate interactions between the toddler and the baby, forcing scheduled interactions may cause stress and resistance, especially if the toddler is not ready for such encounters.

A. Blood pressure 80/50 mm Hg. B. Respiratory rate 55/min. C. Heart rate 72/min. D. Temperature 36.5°C (97.7°F).

Correct Answer is C

Explanation

The correct answer is choice c. Heart rate 72/min.

Choice A rationale:

A blood pressure of 80/50 mm Hg is within the normal range for a full-term newborn.

Choice B rationale:

A respiratory rate of 55/min is also within the normal range for a newborn, which typically ranges from 30 to 60 breaths per minute.

Choice C rationale:

A heart rate of 72/min is significantly lower than the normal range for a newborn, which is typically between 120 to 160 beats per minute. This bradycardia should be reported to the provider as it may indicate an underlying issue.

Choice D rationale:

A temperature of 36.5°C (97.7°F) is within the normal range for a newborn, which is generally between 36.5°C to 37.5°C (97.7°F to 99.5°F).

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A nurse is caring for a newborn who has neonatal abstinence syndrome. Which of the following actions should the nurse take?

Nursing Test Bank

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