A nurse in the newborn nursery is caring for a group of newborns. Which of the following newborns requires immediate intervention?
A newborn who is 18 hr post-delivery and has acrocyanosis
A newborn who is 24-hr post-delivery and has not passed meconium
A newborn who is 24 hr post-delivery and has persistent tachycardia with a heart rate of 180 bpm
A newborn who is 24 hr post-delivery and has not voided
The Correct Answer is C
A. Acrocyanosis is a normal finding in newborns and does not require immediate intervention.
B. Not passing meconium within the first 24 hours is not uncommon and may be normal.
C. Persistent tachycardia in a newborn, especially with a heart rate of 180 bpm, requires immediate intervention as it may indicate a cardiac or other medical issue.
D. Not voiding within the first 24 hours may be normal, but it should be monitored.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. A score of 4 would indicate severe distress, but the baby in this scenario shows signs of responsiveness and activity.
B. A score of 6 suggests moderate adaptation to extrauterine life, considering some components of the APGAR are within the normal range.
C. A score of 10 is perfect, but the noted symptoms suggest some difficulties.
D. A score of 9 would be high and not consistent with the observed signs of distress.
Correct Answer is ["120"]
Explanation
To calculate the infusion rate in gtt/min, the nurse needs to use the formula: gtt/min = (mL/hr x drop factor) / 60
Plugging in the given values, we get:
gtt/min = (120 mL/hr x 60 gtt/mL) / 60
gtt/min = 7200 gtt/hr / 60 gtt/min = 120 gtt/min
Therefore, the nurse should set the manual IV infusion to deliver 120 gtt/min.
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