A nurse is assisting with the care of a newborn who has neonatal abstinence syndrome. Which of the following actions should the nurse take first?
Weigh the newborn's wet diaper.
Auscultate the newborn's bowel sounds.
Determine the newborn's respiratory rate.
Swaddle the newborn in blankets.
The Correct Answer is C
A. weighing the newborn's wet diaper, is a routine part of newborn care but is not the first priority in this situation.
B. auscultating the newborn's bowel sounds, is important for assessing gastrointestinal function but is not the first priority when the baby is at risk for respiratory distress.
C. Neonatal abstinence syndrome (NAS) is a condition that occurs in newborns who were exposed to addictive substances in utero. One of the key concerns in NAS is respiratory distress, so determining the newborn's respiratory rate is the first priority.
D. swaddling the newborn in blankets, is a comfort measure but does not address the immediate concern of assessing respiratory status in a baby with suspected NAS.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. weighing the newborn's wet diaper, is a routine part of newborn care but is not the first priority in this situation.
B. auscultating the newborn's bowel sounds, is important for assessing gastrointestinal function but is not the first priority when the baby is at risk for respiratory distress.
C. Neonatal abstinence syndrome (NAS) is a condition that occurs in newborns who were exposed to addictive substances in utero. One of the key concerns in NAS is respiratory distress, so determining the newborn's respiratory rate is the first priority.
D. swaddling the newborn in blankets, is a comfort measure but does not address the immediate concern of assessing respiratory status in a baby with suspected NAS.
Correct Answer is A
Explanation
A. Increased uterine tone: Methylergonovine is a medication used to prevent or treat postpartum hemorrhage. It works by causing uterine contractions, which helps to control bleeding. An indication that the medication is effective would be an increase in uterine
tone, as this signifies that the uterus is contracting appropriately.
B. Blood pressure 120/74 mm Hg: While a blood pressure of 120/74 mm Hg is within the normal range, it does not specifically indicate the effectiveness of methylergonovine.
Blood pressure is an important parameter to monitor, but it alone does not determine the effectiveness of the medication.
C. Decreased perineal edema: Decreased perineal edema may be a positive sign for the client's overall recovery, but it is not a direct indicator of methylergonovine's
effectiveness. Perineal edema is not a primary concern addressed by this medication.
D. Urinary output 100 mL/hr: Urinary output of 100 mL/hr is an important parameter to monitor for renal function. However, it does not specifically indicate the effectiveness of methylergonovine in preventing or treating postpartum hemorrhage. Urinary output is crucial for assessing kidney function and fluid balance but is not directly related to the action of this medication.
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