A nurse is caring for a newborn who was born prematurely at 26 weeks. Which of the following interventions should the nurse take to decrease the newborn's risk of increased intracranial pressure?
Elevate the head of the bed 15° to 20°.
Stimulate the newborn every 2 hr.
Place the newborn in a radiant warmer.
Administer hypertonic solution.
The Correct Answer is A
Choice A rationale:
Elevating the head of the bed can help prevent intracranial pressure by promoting venous drainage from the head.
Choice B rationale:
Premature newborns need to rest and conserve energy, so excessive stimulation every 2 hours is not recommended.
Choice C rationale:
Placing the newborn in a radiant warmer helps maintain a stable body temperature, but it does not directly address intracranial pressure.
Choice D rationale:
Administering hypertonic solution is not a standard intervention for decreasing intracranial pressure in a premature newborn.
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Related Questions
Correct Answer is D
Explanation
Choice A rationale:
Establishing a therapeutic relationship is important, but the immediate priority is to ensure the safety of the client by maintaining constant observation.
Choice B rationale:
Instructing the client on stress management techniques is important, but safety comes first.
Choice C rationale:
Having the client sign a no-suicide contract may provide some reassurance, but it is not a substitute for constant observation.
Choice D rationale:
Maintaining constant observation of the client is the priority to prevent any further self-harm or suicide attempts.
Correct Answer is A
Explanation
Choice A rationale:
Methylphenidate has been associated with potential growth suppression in children, which is why this statement is important.
Choice B rationale:
Administering the medication at bedtime might interfere with the child's sleep.
Choice C rationale:
Methylphenidate is more likely to cause decreased appetite and weight loss, not weight gain.
Choice D rationale:
Methylphenidate is a stimulant and is more likely to cause increased alertness rather than drowsiness.
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