A nurse is assisting with the care of a newborn who is 4 hr old.

Exhibits

Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

Answer and Explanation

The Correct Answer is []

- Potential Condition: Hypoglycemia

- Rationale: The jitteriness and weak cry can be signs of hypoglycemia, which is common in newborns, especially those with higher birth weights or whose mothers have diabetes or, in this case, a history of substance use during pregnancy.

Actions to Take:

1. Reinforce with the parent to feed the newborn: Feeding can help to stabilize the newborn's blood sugar levels.

2. Anticipate a prescription to obtain a capillary blood sample: This will confirm the diagnosis by measuring the newborn's blood glucose levels.

Parameters to Monitor:

1. Temperature: To ensure the newborn maintains a normal body temperature, as hypothermia can be associated with hypoglycemia.

2. Respiratory status: To monitor for any changes that could indicate worsening of the condition or other complications.

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Correct Answer is B

Explanation

A. Carrots are not a significant source of iron. They are rich in vitamins and fiber but do not contribute substantially to iron needs.
B. Chicken breast is a good source of heme iron, which is more readily absorbed by the body compared to non-heme iron found in plant foods. It helps meet the increased iron requirements during pregnancy.
C. Feta cheese is not a significant source of iron. It provides calcium and protein but does not contribute substantially to iron intake.
D. Apples are not a significant source of iron. While they are nutritious, they do not help meet the increased iron requirements during pregnancy.

A. A client whose newborn is having difficulty latching-on B. A client who received magnesium sulfate during labor C. A client who has a history of oligohydramnios D. A client whose labor lasted for 6 hr

Correct Answer is B

Explanation

A. A client whose newborn is having difficulty latching-on should be addressed, but this issue is not an immediate postpartum emergency. It is important but does not require urgent intervention compared to potential complications from magnesium sulfate.
B. A client who received magnesium sulfate during labor should be seen first because magnesium sulfate can cause significant side effects like respiratory depression, decreased reflexes, and altered mental status. These effects require close monitoring to prevent severe complications.
C. A client who has a history of oligohydramnios requires monitoring but this history does not necessarily indicate an immediate postpartum issue requiring urgent assessment at this time.
D. A client whose labor lasted for 6 hr does not have an immediate concern solely based on labor duration. While it is relevant, it does not indicate an urgent need for assessment compared to the effects of magnesium sulfate.

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Correct Answer is B

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