A nurse is assessing a newborn immediately after a scheduled cesarean delivery. Which of the following assessments should be the nurse’s priority?
Accidental lacerations.
Acrocyanosis.
Respiratory distress.
Hypothermia.
The Correct Answer is C
Choice A rationale
While accidental lacerations can occur during a cesarean delivery, they are not typically the primary concern immediately after delivery.
Choice B rationale
Acrocyanosis, or bluish discoloration of the hands and feet, is common in newborns and is not typically a priority concern immediately after delivery.
Choice C rationale
Respiratory distress is a priority concern in a newborn after a cesarean delivery. Newborns delivered by cesarean may have transient tachypnea of the newborn (TTN), a condition characterized by rapid breathing during the first few hours of life.
Choice D rationale
While hypothermia is a concern in newborns, it is not typically the immediate priority following a cesarean delivery.
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Related Questions
Correct Answer is C
Explanation
Choice A rationale
While it’s important to report concerns to the primary care provider, this does not directly address the mother’s concern about her newborn’s crossed eyes.
Choice B rationale
Strabismus is a condition where the eyes do not properly align with each other, but it is not the same as the normal crossing of a newborn’s eyes.
Choice C rationale
This is the correct answer. Newborns often lack the muscle control to regulate eye movement, which can cause their eyes to cross.
Choice D rationale
Taking the baby to the nursery for further examination may be necessary if there are other concerns, but it does not directly address the mother’s concern about her newborn’s crossed eyes.
Correct Answer is A
Explanation
Choice A rationale
Rh(D) immunoglobulin prevents the formation of Rh antibodies in mothers who are Rh negative. If an Rh-negative mother is exposed to Rh-positive blood, as can happen during pregnancy or childbirth, her immune system may respond by making antibodies against the Rh antigen. This can cause problems in future pregnancies if the baby is Rh positive. Rh(D) immunoglobulin works by preventing the mother’s immune system from recognizing the Rh antigen, thus preventing the formation of antibodies.
Choice B rationale
Rh(D) immunoglobulin does not destroy Rh antibodies in mothers who are Rh negative. Once antibodies have formed, they cannot be destroyed by Rh(D) immunoglobulin.
Choice C rationale
Rh(D) immunoglobulin does not prevent the formation of Rh antibodies in newborns who are Rh positive. The purpose of Rh(D) immunoglobulin is to prevent the mother from forming Rh antibodies.
Choice D rationale
Rh(D) immunoglobulin does not destroy Rh antibodies in newborns who are Rh positive. The purpose of Rh(D) immunoglobulin is to prevent the mother from forming Rh antibodies.
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