A nurse is assessing a pre-term newborn who has retinopathy of prematurity (ROP).

Which of the following manifestations should the nurse expect to observe?

Leukocoria (white pupils)

Strabismus (crossed eyes)

Nystagmus (involuntary eye movements)

All of the above

Answer and Explanation

The Correct Answer is A

Leukocoria (white pupils) is a symptom of retinopathy of prematurity (ROP), an eye disease that can happen in premature babies. ROP happens when abnormal blood vessels grow on the retina, the light-sensitive layer of tissue in the back of the eye.

Choice B is wrong because strabismus (crossed eyes) is not a symptom of ROP, but a possible complication that can occur later in life.

Choice C is wrong because nystagmus (involuntary eye movements) is not a symptom of ROP, but another possible complication that can occur later in life.

Choice D is wrong because it includes choices B and C, which are incorrect.

Normal ranges for gestational age and birth weight are 38 to 42 weeks and 5.5 to 10 pounds, respectively. Babies born before 31 weeks or weighing less than 3 pounds are at risk for ROP.

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Correct Answer is B

Explanation

Tachycardia.

Terbutaline is a medication that can be used to stop or delay preterm labor by relaxing the uterine muscles.However, it can also cause serious side effects for both the mother and the baby.One of the most common side effects of terbutaline is tachycardia, which means a fast or irregular heartbeat.This can lead to chest pain, palpitations, shortness of breath, and even cardiac arrhythmias or ischemia.

Therefore, the nurse should monitor the mother’s heart rate and rhythm closely when administering terbutaline.

Choice A is wrong because terbutaline does not cause hypotension, which means low blood pressure.In fact, terbutaline can increase blood pressure by constricting blood vessels.

Choice C is wrong because terbutaline does not cause hyperglycemia, which means high blood sugar.However, terbutaline can interfere with insulin secretion and glucose metabolism in some cases, especially in diabetic mothers.

Therefore, the nurse should monitor the mother’s blood sugar levels when administering terbutaline.

Choice D is wrong because terbutaline does not cause hypokalemia, which means low potassium levels in the blood.However, terbutaline can cause a temporary increase in potassium levels in the baby, which can affect the baby’s heart function.

Therefore, the nurse should monitor the baby’s heart rate and rhythm when administering terbutaline.

Normal ranges for heart rate are 60 to 100 beats per minute for adults and 120 to 160 beats per minute for fetuses.

Normal ranges for blood pressure aretypically between 90/60 mmHg and 120/80 mmHg.

A. Accelerations B. Early decelerations C. Variable decelerations D. Absent variability

Correct Answer is D

Explanation

According to the search results, magnesium sulfate can have a negative effect on the fetal heart rate (FHR) by lowering the baseline, decreasing the variability, and reducing the reactivity or acceleration pattern.Absent variability means that there is no fluctuation in the FHR and it indicates fetal hypoxia or acidosis.

This is a potential adverse effect of magnesium sulfate on the fetus and requires immediate intervention.

Choice A.Accelerations is wrong because accelerations are transient increases in the FHR that indicate fetal well-being.They are not affected by magnesium sulfate.

Choice B.Early decelerations is wrong because early decelerations are decreases in the FHR that occur with uterine contractions and are caused by fetal head compression.They are benign and do not indicate fetal distress.They are not associated with magnesium sulfate.

Choice C.Variable decelerations is wrong because variable decelerations are abrupt decreases in the FHR that vary in shape, duration, and timing and are caused by umbilical cord compression.

They may or may not indicate fetal compromise.

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A nurse is assessing a pre-term newborn who has retinopathy of prematurity (ROP). Which of the following manifestations should the nurse expect to observe?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is administering terbutaline to a client who is at 31 weeks of gestation and has pre-term labor. Which of the following findings should the nurse monitor as an adverse effect of this medication?

Correct Answer is B

Explanation

A nurse is evaluating the fetal heart rate tracing of a client who is in pre-term labor and receiving magnesium sulfate. The nurse should identify that which of the following patterns indicates a potential adverse effect of the medication on the fetus?

Correct Answer is D

Explanation

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A nurse is assessing a pre-term newborn who has retinopathy of prematurity (ROP).

Which of the following manifestations should the nurse expect to observe?