A nurse is caring for a client who has just delivered a newborn. Following the delivery, which nursing action should be done first to care for the newborn?
Stimulate the infant to cry.
Clear the respiratory tract.
Dry the infant off and cover the head.
Cut the umbilical cord.
The Correct Answer is B
Choice A reason:
Stimulating the infant to cry is an important action as it helps ensure that the baby's lungs are clear of fluid and are functioning properly. However, this is not the first action to take. The initial cry will often occur naturally as part of the transition from intrauterine to extrauterine life.
Choice B reason:
Clearing the respiratory tract is the priority action. Immediately after birth, it is crucial to ensure that the newborn's airway is clear to facilitate breathing. The nurse may suction the mouth and nose to remove any amniotic fluid, mucus, or other obstructions that could impede breathing.
Choice C reason:
Drying the infant off and covering the head is important to prevent heat loss, which newborns are particularly susceptible to due to their large surface area relative to body mass. However, this follows the clearance of the airway, as maintaining an open airway is the most critical initial step in newborn care.
Choice D reason:
Cutting the umbilical cord is a necessary step in the delivery process, but it is not the first action to take when caring for the newborn. The timing of cord clamping can vary, and immediate care focuses on ensuring the newborn's ability to breathe effectively.
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Related Questions
Correct Answer is C
Explanation
Choice A reason:
Introducing fluoride supplements to a newborn is not typically recommended until the age of 6 months, unless advised by a healthcare provider due to specific water supply conditions. The American Academy of Pediatrics (AAP) suggests that fluoride supplementation should begin at 6 months if the water supply is deficient in fluoride.
Choice B reason:
Cow's milk is not recommended for infants under the age of 1 year. Introducing cow's milk before this age can lead to iron deficiency and potentially cause harm to the infant's developing kidneys. It also lacks the proper nutrients that infants require, which are found in breast milk or formula.
Choice C reason:
The AAP recommends that fruit juice should not be introduced to infants before 6 months of age. Before this age, babies should only be fed breast milk or formula. Introducing fruit juice too early can contribute to excessive weight gain and tooth decay.
Choice D reason:
The introduction of solid foods is recommended to start at around 6 months of age. Starting solid foods at 3 months is too early and can increase the risk of choking and may lead to the development of food allergies.
Correct Answer is C
Explanation
Choice A reason: During the taking-in phase, the mother is often passive and may not yet show eagerness to learn newborn care skills. This phase is more about recovery and processing the birth experience.
Choice B reason: Lack of appetite might be present immediately after birth due to the exertion and possible nausea, but it is not a defining characteristic of the taking-in phase. The mother's appetite usually returns as she begins to recover.
Choice C reason: Expressions of excitement are common as the mother relives the delivery experience and begins to bond with the baby. This emotional response is part of the taking-in phase, where the mother is focused on her own experience and the reality of becoming a parent.
Choice D reason: While the focus on the family unit is important, during the taking-in phase, the mother is primarily oriented to her own needs and recovery. The focus on family members and the broader family unit becomes more prominent in the subsequent taking-hold phase.
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