A nurse is providing care for a newborn suspected of having neonatal abstinence syndrome. Which symptom would support this diagnosis?

Decreased muscle tone

Sleeps for 2 hours after feeding

Continuous high-pitched cry

Mild tremors when disturbed

Answer and Explanation

The Correct Answer is C

Choice A rationale
Decreased muscle tone is not typically associated with neonatal abstinence syndrome (NAS). NAS is a condition that affects newborns who have been exposed to addictive opiate drugs while in the mother’s womb.
Choice B rationale
Sleeping for 2 hours after feeding is not a specific symptom of NAS. While changes in sleep patterns can occur in NAS, they are not definitive indicators of the condition.
Choice C rationale
A continuous high-pitched cry is a common symptom of NAS123. This is because the baby is going through withdrawal from the drugs they were exposed to in the womb.
Choice D rationale
Mild tremors when disturbed are indeed a symptom of NAS123. However, this symptom alone is not enough to diagnose NAS as it can be seen in other conditions as well.

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Correct Answer is D

Explanation

Choice A rationale
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug (NSAID) that reduces fever, pain and inflammation. It is used to treat moderate to severe osteoarthritis, rheumatoid arthritis, gouty arthritis, or ankylosing spondylitis. It is not used to accelerate fetal lung maturity.
Choice B rationale
Nifedipine (Procardia) is a calcium channel blocker used to treat high blood pressure (hypertension) or chest pain (angina). It is not used to accelerate fetal lung maturity.
Choice C rationale
Calcium gluconate is used to prevent or to treat calcium deficiencies. It is not used to accelerate fetal lung maturity.
Choice D rationale
Betamethasone (Celestone) is a corticosteroid that is used to mature the lungs in fetuses at risk for preterm birth.

A. Insert an IV catheter. B. Assist the client into the left-lateral position. C. Apply a fetal scalp electrode. D. Perform a vaginal exam.

Correct Answer is B

Explanation

Choice A rationale
While inserting an IV catheter can be a part of the overall management plan for a client showing late decelerations on the electronic fetal monitor, it is not the initial course of action. The primary concern with late decelerations is that they may indicate fetal hypoxia, and the first response should be aimed at improving fetal oxygenation.
Choice B rationale
Assisting the client into the left-lateral position is the correct initial response when late decelerations are observed on the electronic fetal monitor. This position helps to maximize blood flow to the uterus and placenta, thereby improving oxygen delivery to the fetus.
Choice C rationale
Applying a fetal scalp electrode may be useful for obtaining a more accurate fetal heart rate tracing, but it is not the initial response to late decelerations. The priority is to address the potential fetal hypoxia that late decelerations may indicate.
Choice D rationale
Performing a vaginal exam would not be the initial response to late decelerations. While a vaginal exam can provide valuable information about the progress of labor, it does not address the issue of potential fetal hypoxia indicated by late decelerations.

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A nurse is providing care for a newborn suspected of having neonatal abstinence syndrome. Which symptom would support this diagnosis?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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