A nurse is assisting in the care of a newborn immediately following birth. The nurse notes mucus bubbling out of the newborn's mouth and nose. Which of the following actions should the nurse take first?
Place the newborn in the Trendelenburg position.
Administer saline drops into the newborn's nares.
Suction the newborn's mouth with a bulb syringe.
Perform deep suctioning of the newborn's trachea with an endotracheal tube.
The Correct Answer is C
Choice A rationale: Placing the newborn in the Trendelenburg position (head down, feet up) is not recommended in this situation and can potentially cause harm.
Choice B rationale: While saline drops can help clear nasal congestion, the bubbling mucus is coming from the mouth and nose, and suctioning is more appropriate.
Choice C rationale: The bubbling mucus indicates the presence of mucus and amniotic fluid in the baby's airway, which could interfere with breathing. The first action should be to suction the newborn's mouth to clear the airway.
Choice D rationale: Performing deep suctioning with an endotracheal tube is an invasive procedure and is not necessary for clearing mucus from the newborn's mouth and nose.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale: While colostrum is present in the first few days after delivery, it takes a few more days for breast milk to "come in" and increase in volume.
Choice B rationale: Waiting for 6 to 8 days for breast milk to come in would be too long after childbirth. Breast milk typically "comes in" sooner, around 3 to 5 days after delivery.
Choice C rationale: Colostrum, the first milk, is typically produced in small amounts during the first few days after delivery. Breast milk usually "comes in" or increases in volume around 3 to 5 days after childbirth. This transition from colostrum to mature milk is normal and expected.
Choice D rationale: Waiting for 10 days for breast milk to come in would be too long after childbirth. Breast milk typically "comes in" sooner, around 3 to 5 days after delivery.
Correct Answer is ["A","B","C","D"]
Explanation
Choice A rationale: Around 10 to 12 months of age, babies develop more advanced oral motor skills and can start to use their tongue to push solid objects out of their mouth. This is a natural reflex that helps prevent choking as they continue to learn how to eat solid foods.
Choice B rationale: Between 8 to 10 months of age, babies start to develop the ability to chew and swallow soft, cooked food. At this stage, they are typically introduced to mashed or finely chopped solid foods to complement their breast milk or formula diet.
Choice C rationale: Newborns typically start with bottle-feeding or breastfeeding. As they grow and develop, they eventually transition to drinking from a cup, which is usually introduced around 6 to 9 months of age. At this stage, the baby is held by another person while they drink from a cup with assistance.
Choice D rationale: Around 6 to 8 months of age, infants start showing an interest in self-feeding and may begin experimenting with a spoon. They may try to scoop food with a spoon but often need assistance and are still primarily dependent on being fed by a caregiver.
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