A nurse is collecting data from a newborn who was born 2 hr ago to a client who had gestational diabetes mellitus. Which of the following manifestations should the nurse expect if the newborn is experiencing hypoglycemia? (Select all that apply.)

Seizures

Jitteriness

Hypertonia

Hypothermia

Lethargy

Answer and Explanation

Correct Answer : A,B,D,E

A. Seizures. Severe neonatal hypoglycemia can cause seizures due to impaired brain function from inadequate glucose supply. Prolonged or untreated hypoglycemia increases the risk of neurological complications, making seizure activity a serious sign requiring immediate intervention.
B. Jitteriness. Jitteriness or tremors are common early signs of hypoglycemia in newborns. This occurs due to the nervous system's increased excitability when glucose levels are too low to support normal brain function. If jitteriness is observed, blood glucose levels should be checked promptly.
C. Hypertonia. Hypoglycemia is more commonly associated with hypotonia (decreased muscle tone) rather than hypertonia (increased muscle tone). Low glucose levels impair neuromuscular function, leading to lethargy and reduced muscle strength rather than excessive stiffness or rigidity.
D. Hypothermia. Hypoglycemia can interfere with the newborn’s ability to regulate body temperature, leading to hypothermia. Newborns rely on glucose for energy to maintain thermoregulation, and a drop in glucose levels can result in cold stress, further exacerbating hypoglycemia.
E. Lethargy. Lethargy is a common manifestation of neonatal hypoglycemia, as insufficient glucose deprives the brain of its primary energy source. Affected newborns may have poor feeding, weak cry, and decreased responsiveness, all of which indicate the need for prompt glucose monitoring and intervention.

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Correct Answer is D

Explanation

A. Administer NSAIDs every 4 to 6 hr. NSAIDs help manage postpartum pain and inflammation but do not prevent thrombophlebitis. While pain control may encourage mobility, NSAIDs alone do not address the underlying risk of blood clot formation.
B. Apply warm, moist packs to the client's lower legs. Warm compresses may be used for comfort if a clot is already present, but they are not a preventive measure. Applying heat without medical indication may increase the risk of complications if a deep vein thrombosis (DVT) is present.
C. Apply elastic stockings before the client gets out of bed. Compression stockings help reduce venous stasis, but they should be used alongside movement rather than as a sole prevention method. They are most effective when combined with early ambulation and proper hydration.
D. Have the client ambulate as often as possible. Early and frequent ambulation is the most effective way to prevent thrombophlebitis after a cesarean birth. Walking promotes circulation, reduces venous stasis, and lowers the risk of blood clot formation, which is increased due to pregnancy-related hypercoagulability.

A. Take an over-the-counter antacid B. Eat dry, bland foods in the morning C. Restrict fluids to 1,000mL/day D. Increase intake of fresh fruits

Correct Answer is B

Explanation

A. Take an over-the-counter antacid. Antacids are primarily used for heartburn, not for nausea and vomiting during pregnancy. While some antacids may provide mild relief, they are not the first-line recommendation for managing morning sickness. Instead, dietary and lifestyle modifications are preferred.
B. Eat dry, bland foods in the morning. Consuming dry, bland foods such as crackers or toast before getting out of bed can help manage nausea by stabilizing blood sugar levels and preventing an empty stomach, which can worsen symptoms. Eating small, frequent meals throughout the day can also help prevent nausea from returning.
C. Restrict fluids to 1,000 mL/day. Fluid restriction is not recommended, as adequate hydration is essential during pregnancy. Instead, clients experiencing nausea should sip fluids between meals rather than with meals to reduce gastric fullness and discomfort. Dehydration can worsen nausea and increase the risk of complications.
D. Increase intake of fresh fruits. While fresh fruits provide essential vitamins and hydration, they may not specifically alleviate nausea. Some acidic or high-fiber fruits can even trigger nausea in sensitive individuals. Instead, clients should focus on easily digestible foods and consume fluids separately from meals.

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A nurse is collecting data from a newborn who was born 2 hr ago to a client who had gestational diabetes mellitus. Which of the following manifestations should the nurse expect if the newborn is experiencing hypoglycemia? (Select all that apply.)

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching with a newly licensed nurse concerning a client on a postpartum unit following a cesarean birth. Which of the following measures should the nurse include in the instructions to prevent thrombophlebitis?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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