The nurse is caring for a 5-day-old newborn with patent ductus arteriosus with the following vital signs: pulse 160 beats per minute, respirations 80 breaths per minute, oxygen saturation 92 Which order should the nurse querry
Administer furosemide.
Begin indomethacin infusion.
Initiate intravenous access.
Feed a high-calorie formula every two hours.
The Correct Answer is B
Choice A rationale
Administering furosemide, a loop diuretic, is often utilized in the management of patent ductus arteriosus (PDA) to decrease pulmonary congestion. This medication works by inhibiting sodium and chloride reabsorption in the ascending limb of the loop of Henle, which promotes diuresis and reduces the fluid volume overload contributing to respiratory distress, but it is not the primary mechanism to close the defect. The newborn's vital signs, especially the tachypnea and mild desaturation, suggest significant pulmonary overflow that needs corrective intervention.
Choice B rationale
Indomethacin, a nonsteroidal anti-inflammatory drug (NSAID), is a prostaglandin synthesis inhibitor which is the primary pharmacological treatment for closing a hemodynamically significant PDA in a premature infant. Prostaglandins, particularly PGE_2, maintain ductal patency, so blocking their production allows the ductus arteriosus to constrict and eventually close. The elevated pulse and respiratory rate in this newborn indicate a large left-to-right shunt requiring this specific closure therapy.
Choice C rationale
Initiating intravenous access is a necessary procedural step for administering medications like indomethacin or furosemide, but it is not the therapeutic "order" that directly addresses the pathophysiology of the PDA. Securing IV access is a prerequisite action for treatment, but Choice B represents the most critical therapeutic order to question for a patient presenting with symptomatic PDA and signs of pulmonary overcirculation.
Choice D rationale
While newborns with PDA often have increased caloric needs due to the work of breathing and potential heart failure, feeding a high-calorie formula every two hours is a supportive measure, not the urgent primary treatment. Furthermore, frequent, large feeds may exacerbate respiratory distress or necrotizing enterocolitis due to gut hypoperfusion in a severely compromised infant. The priority is to close the PDA and stabilize the cardiorespiratory status.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While positioning the child upright can help improve lung expansion and ease breathing, it is not the most immediate priority when a child has significant signs of respiratory distress, including labored breathing and a low oxygen saturation of 90. The immediate need is to increase the partial pressure of oxygen in the blood to prevent hypoxemia and potential organ damage.
Choice B rationale
The child is showing signs of hypoxemia and respiratory compromise (labored breathing, cough, oxygen saturation 90) following a near-drowning incident. Oxygen administration is the priority intervention to increase arterial oxygen saturation and ensure adequate oxygen delivery to tissues. A saturation of 90 is a clinical sign of respiratory insufficiency requiring supplemental oxygenation.
Choice C rationale
Sedation should be avoided in a child with respiratory distress unless agitation is significantly interfering with ventilatory efforts or necessary procedures. Sedatives can further depress respiratory drive, potentially worsening hypoventilation and the existing hypoxemia, which would be detrimental to the child's recovery in this critical scenario.
Choice D rationale
Checking capillary refill time is an assessment of peripheral perfusion, which is important but secondary to immediate oxygenation and ventilation support. While circulatory status is critical, addressing the life-threatening hypoxemia, as indicated by the 90 oxygen saturation, takes precedence in the initial management of a respiratory emergency.
Correct Answer is B
Explanation
Choice A rationale
Diabetes mellitus, a disorder of glucose metabolism (normal blood glucose 70-100 mg/dL), is not a direct or common complication of bulimia nervosa, which is characterized by binging and compensatory behaviors like purging, although weight fluctuations can impact metabolic health.
Choice B rationale
Severe erosion of teeth, specifically dental enamel, is a common and severe complication of bulimia nervosa, primarily caused by repeated self-induced vomiting where gastric acid bathes the teeth, leading to demineralization and loss of protective structure.
Choice C rationale
Hypertension (normal blood pressure varies by age, generally <120/80 mm Hg in adults) is not typically a direct complication of bulimia nervosa; instead, fluid and electrolyte imbalances (e.g., hypokalemia) and cardiovascular issues like arrhythmias are more characteristic concerns.
Choice D rationale
Atherosclerosis, which involves the hardening and narrowing of arteries due to plaque buildup, is a long-term cardiovascular risk generally associated with conditions like hyperlipidemia, obesity, and diabetes, not an immediate or direct complication of bulimia nervosa.
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