A nurse is caring for a newborn who is large for gestational age and is 12 hours old.
Which of the following laboratory tests should the nurse monitor based on the client's condition?
Bilirubin.
Glucose.
White blood cell count.
Arterial blood gases.
The Correct Answer is B
Choice A rationale
Bilirubin monitoring is critical for jaundice due to hemolysis, often seen in ABO incompatibility or cephalohematoma. While Large for Gestational Age (LGA) infants can have polycythemia, hypoglycemia is a more immediate and life-threatening risk that requires priority monitoring in the first hours of life. The normal total bilirubin range is typically less than 5 mg/dL in the first 24 hours.
Choice B rationale
LGA infants are often born to mothers with uncontrolled or gestational diabetes, leading to fetal hyperinsulinism. After birth, the maternal glucose supply is cut off, and the high insulin levels persist, causing a rapid and profound drop in the newborn's blood glucose, hence hypoglycemia is a major concern. The normal newborn glucose range is 40 to 60 mg/dL and should be monitored.
Choice C rationale
White blood cell (WBC) count is primarily monitored to detect neonatal sepsis or infection. While all newborns are at risk, the LGA classification does not inherently place them at a higher, unique risk for infection compared to the immediate metabolic derangement risks like hypoglycemia. The normal WBC count range is 9,000 to 30,000 cells/mm.
Choice D rationale
Arterial Blood Gases (ABGs) are used to assess the newborn's respiratory status and acid-base balance, particularly in respiratory distress syndrome or persistent pulmonary hypertension. While LGA infants can experience birth trauma or meconium aspiration, ABG monitoring is not routine unless significant respiratory symptoms are present.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Methylergonovine is an uterotonic agent that acts on the smooth muscle of the uterus to stimulate strong, sustained contractions, which are essential for compressing the intramyometrial blood vessels and achieving hemostasis to stop postpartum hemorrhage, especially from uterine atony.
Choice B rationale
While oxygen is important for hypoxia secondary to blood loss, administering it at 2 L/min via nasal cannula is typically insufficient for a client experiencing significant hemorrhage. High-flow oxygen, such as 10 to 15 L/min via nonrebreather mask, is usually required to maximize oxygen saturation.
Choice C rationale
Starting an IV bolus of Dextrose 5.
Choice D rationale
The knee-chest position is generally used to relieve cord compression or help with the manual rotation of the fetus, but it is not an established intervention for managing postpartum hemorrhage. The client should be positioned flat with legs elevated to promote venous return and manage shock.
Correct Answer is A
Explanation
Choice A rationale
The umbilical cord stump typically dries, shrivels, and spontaneously separates from the infant's abdomen due to a process similar to dry gangrene (ischemic necrosis) within one to three weeks after birth; therefore, this statement indicates correct understanding of the normal timeline for cord care and healing.
Choice B rationale
A newborn's skin is sensitive and prone to drying, and daily tub baths are unnecessary and may cause skin irritation; sponge baths are used until the cord stump falls off, and then typically only two to three baths per week are recommended initially to maintain skin integrity.
Choice C rationale
The correct procedure for using a bulb syringe is to compress the bulb before insertion into the mouth (or nose) to create the negative pressure, then release the compression slowly to suction mucus; compressing it after insertion would expel air into the baby's mouth instead of suctioning.
Choice D rationale
Placing a baby on their side to sleep increases the risk of the baby rolling onto their stomach, which is associated with an elevated risk of Sudden Infant Death Syndrome (SIDS); the universally recommended safe sleep position is supine (on the back).
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