A newborn was admitted to the hospital with vomiting and dehydration. The newborn's heart rate is 170, respiratory rate is 44, blood p 85/52, and temperature is 99 Degree F (37.2 Degree C). What is the nurse's best response to the parents who ask if the vital signs are normal?
"The blood pressure is elevated, but the other vital signs are within normal limits”
"The heart rate is elevated, but the other vital signs are within normal limits"
"The temperature is elevated, but the other vital signs are within normal limits"
“The respiratory rate is elevated, but the other vital signs are within normal limits"
The Correct Answer is B
While the newborn's heart rate of 170 bpm is elevated, the respiratory rate of 44 breaths/min, blood pressure of 85/52 mmHg, and temperature of 99°F (37.2°C) are within the normal range for a newborn.
It is important for the nurse to explain to the parents that the newborn's heart rate may be elevated due to the vomiting and dehydration and that healthcare providers will monitor the vital signs closely to ensure the newborn's stability.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The inability to raise the head when in a prone position is a finding that the nurse should report to the provider. By 6 months of age, infants should typically be able to raise their head and chest off the surface when placed in a prone position. This is an important milestone in motor development and is known as "head control." The nurse should report this finding to the provider to ensure further assessment and appropriate intervention if necessary.
Correct Answer is C
Explanation
Hospitalization can be a challenging and unfamiliar experience for children, especially when they are separated from their family and siblings. Providing clear information about visitation policies and explaining the reasons for restrictions can help the child understand and cope better with the situation.
While orienting her parents and explaining hospital schedules can be beneficial, the focus should be on directly addressing the needs and concerns of the child to support her adjustment. Using caring and comforting language is important, but it should be combined with age-appropriate explanations and addressing specific concerns related to the child's situation.
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