A nurse is caring for a newborn who is 8 hours old.
Based on the information in the newborn’s medical record, the nurse determines that the newborn is at risk for developing which of the following complications?
Hypoglycemia.
Neonatal abstinence syndrome.
Hyperbilirubinemia.
Drug withdrawal symptoms.
The Correct Answer is A
Choice A rationale
Hypoglycemia is a common complication in newborns, especially those who are 8 hours old. The newborn’s body has not yet fully developed the ability to regulate blood sugar levels, leading to hypoglycemia.
Choice B rationale
Neonatal abstinence syndrome is typically seen in newborns exposed to addictive illegal or prescription drugs while in the mother’s womb. Without additional context, it’s not clear if this applies to the newborn in question.
Choice C rationale
Hyperbilirubinemia, or jaundice, is a condition that can occur in newborns, usually a few days after birth. However, it’s less likely to develop within the first 8 hours of life.
Choice D rationale
Drug withdrawal symptoms are similar to neonatal abstinence syndrome and occur in newborns who have been exposed to certain drugs while in the womb. Again, without additional context, it’s not clear if this applies to the newborn in question.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Vitamin K is used to reverse the effects of warfarin. Warfarin is an anticoagulant that works by inhibiting the synthesis of vitamin K-dependent clotting factors. When the INR is too high, indicating a high risk of bleeding, vitamin K can be administered to increase the production of clotting factors and reduce the risk.
Correct Answer is C
Explanation
Choice A rationale
Having the patient void is not the immediate priority. While it is important to ensure the bladder is not distended, which could interfere with labor progress, the vital signs suggest a more urgent concern.
Choice B rationale
Asking the patient if she needs pain medication is important for comfort measures during labor, but it is not the immediate priority. The nurse’s first responsibility is to ensure the safety of the mother and baby.
Choice C rationale
Turning the patient on her side and rechecking the blood pressure is the correct action. The maternal blood pressure is low, which could indicate supine hypotensive syndrome. This occurs when the gravid uterus compresses the inferior vena cava when the woman is supine, reducing venous return to the heart. Turning the woman on her side may relieve this pressure and improve blood pressure.
Choice D rationale
Notifying the healthcare provider of the findings is important, but it is not the first action the nurse should take. The nurse should first address the mother’s hypotension by turning her on her side.
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