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 A

Explanation

A. Referral to community services for support.

A client in preterm labor who is being discharged from the hospital needs to have a discharge plan that includes education, follow-up care, and support services.A referral to community services for support can help the client cope with the stress and anxiety of preterm labor, access resources such as home health care or social workers, and prevent complications or recurrence of preterm labor.

B. Encouragement to smoke in moderation is wrong because smoking is harmful for both the mother and the baby.

Smoking can increase the risk of preterm labor, low birth weight, placental abruption, and sudden infant death syndrome (SIDS).Smoking should be avoided completely during pregnancy and after delivery.

C. Instructions for heavy lifting and strenuous exercise is wrong because these activities can trigger uterine contractions and increase the risk of preterm labor.

A client in preterm labor should rest as much as possible and avoid physical exertion.The client should also avoid sexual intercourse, which can stimulate the cervix and cause bleeding or infection.

D. Recommendation to avoid kangaroo care is wrong because kangaroo care is a method of holding a newborn skin-to-skin with the mother or father.

Kangaroo care can have many benefits for preterm babies, such as improving temperature regulation, breathing, heart rate, feeding, bonding, and growth.Kangaroo care can also reduce stress and pain for both the baby and the parent.

A. Thromboembolism B. Placental abruption C. Uterine atony D. Infection

Correct Answer is A

Explanation

Thromboembolism.

Prolonged bed rest increases the risk of venous stasis and blood clot formation in the lower extremities, which can lead to pulmonary embolism if the clot dislodges and travels to the lungs.

This is a life-threatening complication that requires immediate treatment.

Choice B. Placental abruption is wrong because it is not caused by bed rest, but by trauma, hypertension, cocaine use, or other factors that can cause the placenta to separate from the uterine wall.

Choice C. Uterine atony is wrong because it is not caused by bed rest, but by overdistension of the uterus, prolonged labor, infection, or other factors that can impair the contraction of the uterine muscles after delivery.

Choice D. Infection is wrong because it is not caused by bed rest, but by poor hygiene, invasive procedures, or other factors that can introduce microorganisms into the reproductive tract.

Normal ranges for maternal heart rate are 60-100 beats per minute and blood pressure are 110-140/60-90 mm Hg.

Normal range for fetal heart rate is 110-160 beats per minute.

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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

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Correct Answer is A

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Correct Answer is A

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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?