A nurse is caring for a newborn who is 70 hours old in the newborn nursery.

Exhibits

For each assessment finding, click to specify if the finding is consistent with hypoglycemia or neonatal abstinence syndrome (NAS). Each finding may support more than one disease process.

The nurse should anticipate a provider prescription for pyridoxine due to the client’s severe dehydration.

Rationale for correct answers

Pyridoxine (vitamin B6) is recommended for nausea and vomiting in pregnancy (NVP), commonly known as hyperemesis gravidarum (HG), especially in patients with persistent symptoms leading to dehydration. Severe dehydration is confirmed by elevated urine specific gravity (normal: 1.002–1.030), low sodium (normal: 135–145 mEq/L), and positive ketones, indicating excessive vomiting and malnutrition.

Rationale for incorrect Response 1 options

• Antibiotics: There is no evidence of infection; urinalysis and WBC count are within normal limits.
• Magnesium sulfate: Used for eclampsia or preterm labor prevention, not for HG.
• Oxytocin: Stimulates uterine contractions and is contraindicated during early pregnancy unless labor induction is required.

Rationale for incorrect Response 2 options

• Urinary tract infection: No leukocytes or nitrites in urine, and WBC count is normal (4,500–11,000/mm³).
• Preeclampsia: No proteinuria or hypertension (≥140/90 mm Hg).
• Preterm labor: No uterine contractions or cervical changes.

Choice A rationale

Proteinuria, the presence of protein in the urine, is not a typical immediate complication following an amniocentesis. It is more commonly associated with preeclampsia, a condition of pregnancy. While the nurse would monitor the patient's overall condition, proteinuria is not a direct risk related to the amniocentesis procedure itself.

Choice B rationale

Hemorrhage is a potential complication following an amniocentesis. The procedure involves inserting a needle through the abdominal wall and uterus to withdraw amniotic fluid, which carries a risk of bleeding at the insertion site, within the uterus, or even fetomaternal hemorrhage (bleeding from the fetal circulation into the maternal circulation). The nurse must monitor for signs of bleeding, such as increased pain, decreased blood pressure, or vaginal bleeding.

Choice C rationale

Hypoxia, a deficiency in the amount of oxygen reaching the tissues, is not a direct immediate complication of amniocentesis for the mother. While fetal well-being is monitored during and after the procedure, maternal hypoxia is not a typical risk associated with the amniocentesis itself.

Choice D rationale

Infection is a significant potential complication following an amniocentesis. The invasive nature of the procedure creates a risk of introducing bacteria into the amniotic cavity or the maternal tissues. The nurse should observe for signs of infection such as fever, chills, abdominal tenderness, or leakage of fluid from the insertion site.