1. A nurse is obtaining a capillary blood sample from a newborn for phenylketonuria testing. Identify the sequence of steps the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
Puncture the heel and collect the blood.
Apply pressure with a dry gauze pad.
Wrap a warm, moist cloth around the heel.
Cover the heel with an adhesive bandage.
Cleanse the heel with an antiseptic.
The Correct Answer is C,E,A,B,D
1. Wrap a warm, moist cloth around the heel to dilate the blood vessels, which makes it easier to obtain the blood sample.
2. Cleanse the heel with an antiseptic to reduce the risk of infection at the puncture site.
3. Puncture the heel and collect the blood, ensuring that the sample is adequate for the test.
4. Apply pressure with a dry gauze pad to stop the bleeding from the puncture site.
5. Cover the heel with an adhesive bandage to protect the area and minimize the risk of infection.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Each feeding should ideally last about 20 to 30 minutes, but it is essential to monitor the baby’s cues for hunger and fullness, rather than strictly adhering to time.
B. Leftover formula from a feeding should not be refrigerated for reuse; it should be discarded to prevent bacterial growth.
C. Prepared formula can indeed be stored in the refrigerator for up to 2 days, making this statement accurate for safe feeding practices.
D. It is recommended to burp the baby during and after feedings, not just at the end, to help release any air swallowed during feeding and prevent discomfort.
Correct Answer is C
Explanation
A. A Mongolian spot is a benign, pigmented skin mark common in newborns, particularly those with darker skin. It is not related to rubella exposure during pregnancy.
B. Jaundice in the newborn can be a common finding and is not specifically related to maternal rubella exposure. Jaundice often resolves with time or may require treatment, but it is not a direct consequence of rubella.
C. Deafness is a known congenital defect associated with rubella syndrome. Infants exposed to rubella during pregnancy are at risk for serious outcomes, including hearing impairments.
D. Transient strabismus is a common condition in newborns and is not specifically associated with maternal rubella exposure. It typically resolves as the baby grows.
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