A nurse is formulating a care plan for a newborn who is small for gestational age (SGA). Which of the following should be the priority intervention in the newborn’s care plan?
Monitor weight.
Monitor I&O.
Monitor axillary temperature.
Monitor blood glucose levels.
The Correct Answer is D
Choice A rationale
Monitoring weight is important for a newborn who is small for gestational age (SGA), but it is not the priority intervention. Weight can provide information about the newborn’s growth and development, but it does not address immediate physiological needs.
Choice B rationale
Monitoring I&O (Intake and Output) is crucial in assessing the newborn’s hydration status and kidney function. However, it is not the priority intervention for an SGA newborn.
Choice C rationale
Monitoring axillary temperature is important to maintain the newborn’s thermal regulation. However, it is not the priority intervention. Newborns, especially those who are SGA, are at risk for hypothermia due to their high body surface area to volume ratio and lack of subcutaneous fat.
Choice D rationale
Monitoring blood glucose levels is the priority intervention for an SGA newborn. SGA newborns are at risk for hypoglycemia because they have fewer glycogen stores. Hypoglycemia can lead to serious complications such as seizures, hence the need for close monitoring
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
Encouraging the client to perform Kegel exercises can help strengthen pelvic floor muscles, but it does not address the immediate problem of a displaced and boggy uterus.
Choice B rationale
Assisting the client to the bathroom to void is the correct action. A full bladder can displace the uterus and prevent it from contracting properly, which can lead to uterine atony and increased risk of postpartum hemorrhage.
Choice C rationale
Asking the client to rate her pain is important, but it does not address the immediate problem of a displaced and boggy uterus.
Choice D rationale
Encouraging the client to move to the left lateral position can improve venous return and cardiac output, but it does not address the immediate problem of a displaced and boggy uterus
Correct Answer is C
Explanation
Choice A rationale
Ceftriaxone (Rocephin) is an antibiotic that is often used to treat bacterial infections, but it is not typically the first line of treatment for herpes.
Choice B rationale
Penicillin G intravenously is a type of antibiotic that is often used to treat bacterial infections. However, herpes is a viral infection, and antibiotics are not effective against viruses.
Choice C rationale
Acyclovir is an antiviral medication that is commonly used to treat herpes infections. It works by slowing the growth and spread of the herpes virus in the body. This would be the most appropriate treatment for a patient presenting with symptoms of a herpes outbreak.
Choice D rationale
Betamethasone is a type of corticosteroid that is often used to reduce inflammation. While it might help to reduce some of the inflammation and discomfort associated with herpes lesions, it would not address the underlying viral infection.
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