A nurse is caring for a newborn 1 hr following birth.
Medical History 1000:
39- week gestation
Emergency cesarean birth for abruptio placenta and non-reassuring fetal heart rate
Apgar 5 at 1 min 8 at 5 min
Positive pressure ventilation given for 1 min followed by free flow oxygen Select the 5 findings the nurse should report to the provider.
Hemoglobin
Hematocrit
Heart rate
Serum glucose
White blood cells
Respiratory assessment
Correct Answer : A,B,C,D,F
A, B Monitoring the newborn's hemoglobin and hematocrit levels are important due to the risk of anemia.
C. Monitoring the newborn's heart rate post-birth is crucial for assessing cardiac function and detecting any abnormalities.
F. Positive pressure ventilation was administered to the newborn for 1 minute after birth, indicating a need for respiratory support. The nurse should closely assess the newborn's respiratory status.
D. There may be concerns about the newborn's blood glucose levels, especially if there were any periods of hypoxia or stress during labor and delivery.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A fetal heart rate of 158/min is within the normal range for a fetus.
B. Respirations of 16/min are within the normal range for an adult.
C. Headache can be a symptom of pre-eclampsia, but it does not necessarily indicate magnesium toxicity.
D. Decreased urinary output can indicate renal insufficiency or impaired kidney function, which can be a sign of magnesium toxicity.
Correct Answer is D
Explanation
Cullen's sign is a clinical sign characterized by superficial edema and bruising in the subcutaneous fatty tissue around the umbilicus. It is indicative of intra-abdominal bleeding, such as from a ruptured ectopic pregnancy. Blood in the peritoneum can track along fascial planes to the umbilical area, resulting in discoloration and swelling.
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