A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse Include?

Insert the syringe tip before compressing the bulb.

Suction each of the nares before suctioning the mouth.

insert the tip of the syringe into the center of the newborn's mouth.

Stop suctioning when the newborn's cry sounds clear

Answer and Explanation

The Correct Answer is D

The correct answer is D.

A. Insert the syringe tip before compressing the bulb: This is incorrect. The nurse should compress the bulb syringe first, then gently insert the tip into the newborn's nose, and then release the bulb to create suction for removing the mucus.

B. The client should suction the mouth first then the nares.

C. Insert the tip of the syringe into the center of the newborn's mouth: This is incorrect. The tip of the bulb syringe should be inserted into the side of the baby's mouth to avoid causing discomfort or stimulating the gag reflex.

D. When the newborn's cry may sound clear due to vocalization, but this may indicate that the airways are clear of secretions.

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Correct Answer is A

Explanation

The correct answer is A. Assist the client to turn onto her side.

A. Assisting the client to turn onto her side is the correct intervention. This is because the client's blood pressure is low, and turning onto the side helps improve blood flow to the uterus, reducing the risk of supine hypotension.

B. Assisting the client to an upright position is not the priority in this case. The client is at risk for supine hypotension, and a lateral position is more appropriate.

C. Preparing for a cesarean birth is not indicated based solely on the blood pressure reading. Turning the client onto her side and monitoring the blood pressure response are appropriate initial actions.

D. Preparing for an immediate vaginal delivery is not indicated based solely on the blood pressure reading. The client's condition may improve with positional changes, and further assessment is needed.

A. Apply perineal pressure to the emerging fetal head B. Cut the umbilical cord C. Prevent the perineum from tearing D. Promote delivery of the placenta

Correct Answer is A

Explanation

A. Correct. In rapidly progressing labor, applying gentle perineal pressure helps control the speed of delivery and can prevent or minimize perineal tearing or lacerations. It also helps to manage the delivery of the fetal head, especially in cases where the labor is very rapid which can cause neurologic damage (increased intracranial pressure and dural/subdural tearing).

B. Cutting the umbilical cord is not the priority in this situation. The focus should be on the immediate management of the delivery process and preventing complications related to perineal tearing.

C. Preventing the perineum from tearing: While preventing the perineum from tearing is important, it is not the immediate priority in the context of rapidly progressing labor. The primary focus should be on safely delivering the baby, which involves controlling the delivery of the fetal head to prevent complications.

D. Promoting the delivery of the placenta is a consideration for the third stage of labor, which follows the delivery of the baby. It is not the priority during the active phase of delivery.

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A nurse is teaching a new mother how to use a bulb syringe to suction her newborn's secretions. Which of the following instructions should the nurse Include?

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