A newborn has meconium aspiration at birth. The nurse notes increasing respiratory distress. What action takes priority?
Obtain an oxygen saturation.
Stimulate the baby to increase respirations.
Prepare to initiate ECMO.
Notify the provider at once.
The Correct Answer is D
Choice A) Obtain an oxygen saturation: This is not a priority action because it does not address the underlying cause of the respiratory distress, which is meconium aspiration. Meconium aspiration can cause airway obstruction, inflammation, infection, and pulmonary hypertension in the newborn. Oxygen saturation may be low, but it is not a reliable indicator of the severity of the condition.
Choice B) Stimulate the baby to increase respirations: This is not a priority action because it may worsen the respiratory distress by increasing the work of breathing and causing more meconium to be aspirated. Stimulation may also cause stress and hypoxia in the newborn.
Choice C) Prepare to initiate ECMO: This is not a priority action because it is a last resort treatment for severe cases of meconium aspiration syndrome that do not respond to conventional therapies. ECMO stands for extracorporeal membrane oxygenation, which is a form of life support that bypasses the lungs and provides oxygen to the blood.
ECMO has many risks and complications, such as bleeding, infection, and organ damage. It should only be used when other options have failed and with the consent of the parents.
Choice D) Notify the provider at once: This is the correct action because it allows for prompt assessment and intervention by the provider, who can initiate appropriate treatments for meconium aspiration syndrome. These may include suctioning of the airway, administration of antibiotics, surfactant, or inhaled nitric oxide, and mechanical ventilation . Early treatment can improve the outcomes and reduce the complications of meconium aspiration syndrome.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A: This is incorrect because lanugo is a fine, downy hair that covers the fetus in utero. It usually disappears by the 36th week of gestation, but it may persist in some preterm infants. Lanugo helps to retain body heat and protect the skin from amniotic fluid. Lanugo is not a sign of postmaturity, but of prematurity or intrauterine growth restriction.
Choice B: This is incorrect because a short, chubby appearance is typical of a term infant, who is born between 37 and 42 weeks of gestation. A term infant has a well-developed subcutaneous fat layer that gives them a rounded shape and smooth skin. A term infant also has a head circumference that is proportional to their body length and weight. A short, chubby appearance is not a sign of postmaturity, but of normal development.
Choice C: This is incorrect because vernix caseosa is a white, cheesy substance that covers the fetus in utero. It usually decreases by the 40th week of gestation, but it may remain in some term infants, especially in the skin folds. Vernix caseosa helps to moisturize and protect the skin from amniotic fluid and infection. Vernix caseosa is not a sign of postmaturity, but of term or near-term gestation.
Choice D: This is the correct answer because cracked, peeling skin is a common sign of postmaturity, which occurs when the infant is born after 42 weeks of gestation. A postmature infant has a loss of subcutaneous fat and water that results in dry, wrinkled, and desquamated skin. A postmature infant also has a large head circumference that is disproportionate to their body length and weight. Cracked, peeling skin indicates prolonged exposure to amniotic fluid and placental insufficiency.
Correct Answer is C
Explanation
Choice A: This is incorrect because preeclampsia is a condition characterized by hypertension, proteinuria, and edema that occurs after 20 weeks of gestation. It is not related to abruptio placentae, which is the premature separation of the placenta from the uterine wall. Preeclampsia does not cause petechiae or bleeding around the IV site, but it may cause headache, blurred vision, epigastric pain, or seizures.
Choice B: This is incorrect because anaphylactoid syndrome of pregnancy, also known as amniotic fluid embolism, is a rare and life-threatening complication that occurs when amniotic fluid enters the maternal circulation and triggers an allergic reaction. It is not related to abruptio placentae, but it may occur during labor, delivery, or shortly after birth. Anaphylactoid syndrome of pregnancy does not cause petechiae or bleeding around the IV site, but it may cause respiratory distress, hypotension, cardiac arrest, or disseminated intravascular coagulation.
Choice C: This is the correct answer because disseminated intravascular coagulation (DIC) is a condition in which the blood clotting system is activated abnormally, leading to excessive clot formation and consumption of clotting factors and platelets. This results in bleeding from various sites, such as the IV site, gums, nose, or vagina. DIC is a common complication of abruptio placentae, as the release of thromboplastin from the placenta triggers the clotting cascade. DIC can also cause organ failure, shock, or death if not treated promptly.
Choice D: This is incorrect because puerperal infection, also known as postpartum infection, is a bacterial infection that affects the uterus, vagina, bladder, or wound site after childbirth. It is not related to abruptio placentae, but it may occur due to prolonged labor, cesarean delivery, retained placenta, or poor hygiene. Puerperal infection does not cause petechiae or bleeding around the IV site, but it may cause fever, malaise, foul-smelling lochia, or pelvic pain.
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