A nurse is preparing to perform a heel-stick procedure on a 2-day-old newborn. Which intervention BEST represents nonpharmacologic pain management for neonates?

Applying EMLA cream immediately before the procedure without waiting

Administering an intramuscular opioid prior to the procedure

Distracting the newborn with toys and verbal explanations

Giving a small dose of oral sucrose solution and providing nonnutritive sucking

Answer and Explanation

The Correct Answer is D

A. EMLA cream is a pharmacologic intervention because it contains local anesthetics (lidocaine and prilocaine) that numb the skin. It must be applied 30–60 minutes before the procedure under an occlusive dressing to achieve effective analgesia. Applying it immediately before a heel stick would not provide pain relief and does not qualify as nonpharmacologic.

B. Intramuscular opioids are systemic pharmacologic agents used for moderate to severe pain. They carry risks such as respiratory depression, sedation, and hypotension in neonates, so they are rarely used for minor procedures like heel sticks.

C. Distraction with toys or verbal explanations is ineffective for neonates because infants at 2 days old cannot process or respond to visual or verbal cues. Cognitive engagement strategies work only in older infants and children.

D. Oral sucrose combined with nonnutritive sucking (e.g., using a pacifier) is a safe and evidence-based nonpharmacologic method for reducing procedural pain in neonates. Sucrose triggers the release of endogenous opioids in the central nervous system, which decreases the perception of pain. Nonnutritive sucking provides comfort and a calming effect, further reducing physiological stress responses such as increased heart rate, blood pressure, and crying. Studies show that this intervention effectively lowers behavioral and physiological indicators of pain during minor procedures such as heel sticks, venipuncture, or immunizations. This method is preferred for routine procedures in neonates because it is simple, safe, and effective without the risks associated with pharmacologic agents.

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Correct Answer is B

Explanation

A. Feeling hot when the room is cold is not a typical sign or complication of severe preeclampsia. This symptom is more related to general temperature sensitivity and does not indicate the hematologic or vascular complications associated with preeclampsia.

B. Evidence of bleeding, including gums bleeding, petechiae, and purpura, may indicate thrombocytopenia or a progression toward HELLP syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), a severe complication of preeclampsia. These findings suggest impaired coagulation and increased risk of bleeding, which are life-threatening if not promptly managed. Monitoring for such hematologic complications is essential in severe preeclampsia.

C. Edema of the lower extremities is common in normal pregnancy and mild preeclampsia, but it is not a specific sign of a serious complication. While generalized edema can indicate worsening preeclampsia, isolated lower-extremity edema is not as closely associated with life-threatening complications as bleeding or hematologic abnormalities.

D. Periods of fetal movement followed by quiet periods are typical fetal behavior and do not indicate a maternal complication of preeclampsia. Monitoring for changes in fetal movement is important, but this finding alone does not reflect maternal complications of severe preeclampsia.

A. Difficulty swallowing drooling, hoarseness, and sitting in a tripod position B. Rhinorrhea, congestion, mild sore throat, and hoarseness C. Sudden onset of cough, wheezing, rapid breathing and difficulty swallowing D. Hoarseness, stridor, and a barking cough

Correct Answer is A

Explanation

A. These are classic signs of epiglottitis, a potentially life-threatening condition caused by inflammation and swelling of the epiglottis, usually from Haemophilus influenzae type b. The child often presents suddenly, is toxic-appearing, prefers to sit upright leaning forward (tripod position) to ease breathing, has drooling due to inability to swallow, and may have muffled or hoarse voice. Stridor may develop as airway obstruction worsens. This is a medical emergency.

B. These are symptoms of upper respiratory tract infections, such as the common cold, and are not indicative of epiglottitis, which presents more acutely and severely.

C. Wheezing and cough are more typical of lower airway diseases like croup or bronchiolitis, not epiglottitis. Difficulty swallowing alone is not sufficient without drooling and tripod positioning.

D. These are classic for viral croup, which affects the larynx and trachea. Epiglottitis differs because it progresses rapidly, causes drooling, and children often refuse to lie down.

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A nurse is preparing to perform a heel-stick procedure on a 2-day-old newborn. Which intervention BEST represents nonpharmacologic pain management for neonates?

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Correct Answer is B

Explanation

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Correct Answer is A

Explanation

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