A nurse is caring for four newborns. Which of the following newborns should the nurse assess first?

A newborn who has subconjunctival hemorrhage of the left eye

A newborn who has overlapping suture lines

A newborn who has nasal flaring

A newborn who has rust stained urine

Answer and Explanation

The Correct Answer is C

A. Subconjunctival hemorrhage is common after vaginal delivery and usually harmless.
B. Overlapping suture lines are normal in newborns due to molding during birth.
C. Nasal flaring is a sign of respiratory distress and requires immediate assessment.
D. Rust-stained urine can be due to urate crystals and is usually benign in newborns.

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Correct Answer is B

Explanation

A. Moderate alcohol intake is not a contraindication to COC use.
B. Breastfeeding in the first 6 weeks postpartum is a contraindication to combined oral contraceptives because estrogen can reduce milk supply and increase the risk of thrombosis.
C. High body weight is not an absolute contraindication, though efficacy may be reduced.
D. Age 25 alone is not a contraindication to COCs.

A. Instruct the parent to avoid eye contact with the newborn during feeding. B. Weigh the newborn daily. C. Plan to administer naloxone. D. Instruct the parent to avoid breastfeeding E. Maintain a low stimulation environment F. Swaddle the newborn with flexed extremities. G. Perform Ballard newborn screening each shift.

Correct Answer is ["B","E","F"]

Explanation

A. Instruct the parent to avoid eye contact with the newborn during feeding – This is not recommended. While overstimulation should be minimized, gentle eye contact and bonding are still encouraged during feeding to promote attachment.

B. Weigh the newborn daily – Weight loss and feeding difficulties are common in NAS. Daily weight monitoring is essential to evaluate nutritional status and fluid balance.

C. Plan to administer naloxone – Naloxone is contraindicated in opioid-exposed neonates because it can precipitate acute withdrawal and seizures.

D. Instruct the parent to avoid breastfeeding – Breastfeeding is generally encouraged unless the mother is using illicit substances or is HIV-positive. Methadone is not a contraindication for breastfeeding.

E. Maintain a low stimulation environment – NAS newborns are easily overstimulated. A quiet, dimly lit environment helps reduce symptoms like irritability and tremors.

F. Swaddle the newborn with flexed extremities – Swaddling provides comfort and containment, helping to reduce stress responses in NAS infants.

G. Perform Ballard newborn screening each shift – The Ballard score is used once to assess gestational age and is not repeated every shift.

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A nurse is caring for four newborns. Which of the following newborns should the nurse assess first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who is requesting a combined oral contraceptive (COC). Which of the following findings should indicate to the nurse that the client has a contraindication to COC use?

Correct Answer is B

Explanation

A nurse is caring for a newborn who is 5 days old. Exhibits Which of the following actions should the nurse take? Select all that apply.

Correct Answer is ["B","E","F"]

Explanation

A nurse is reviewing the medical record of a client who is requesting an oral contraceptive for birth control. The nurse should identify which of the following findings as a contraindication for the use of oral contraceptives for this client?

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