A nurse is caring for a newborn and hears an apical heart rate of 130/min. What should the nurse do next?
Document this as an expected finding.
Call the provider to further assess the newborn.
Prepare the newborn for transport to the NICU.
Ask another nurse to verify the heart rate.
The Correct Answer is A
Choice A rationale
A newborn’s heart rate normally varies between 120 and 160 beats per minute, but it can rise to 180 beats per minute when the infant is crying or drop as low as 80 to 90 beats per minute when in deep sleep. Therefore, an apical heart rate of 130/min is within the normal range for a newborn.
Choice B rationale
There is no need to call the provider for further assessment if the newborn’s heart rate is within the normal range.
Choice C rationale
Preparing the newborn for transport to the NICU is not necessary if the heart rate is within the normal range.
Choice D rationale
Asking another nurse to verify the heart rate is not necessary if the heart rate is within the normal range.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Practicing Kegel exercises is a common recommendation for postpartum women experiencing urinary incontinence. Kegel exercises strengthen the pelvic floor muscles, which support the uterus, bladder, small intestine, and rectum. Strengthening these muscles can help control urinary incontinence.
Choice B rationale
Abdominal crunches are not typically recommended for postpartum women, especially those who have had a cesarean birth. These exercises can strain the abdominal muscles and may interfere with the healing process.
Choice C rationale
Similar to abdominal crunches, sit-ups are not typically recommended for postpartum women, especially those who have had a cesarean birth. These exercises can strain the abdominal muscles and may interfere with the healing process.
Choice D rationale
While pelvic tilt exercises can be beneficial for postpartum women, they are not specifically targeted at improving urinary incontinence.
Correct Answer is D
Explanation
Choice A rationale
Indomethacin (Indocin) is a nonsteroidal anti-inflammatory drug (NSAID) that reduces fever, pain and inflammation. It is used to treat moderate to severe osteoarthritis, rheumatoid arthritis, gouty arthritis, or ankylosing spondylitis. It is not used to accelerate fetal lung maturity.
Choice B rationale
Nifedipine (Procardia) is a calcium channel blocker used to treat high blood pressure (hypertension) or chest pain (angina). It is not used to accelerate fetal lung maturity.
Choice C rationale
Calcium gluconate is used to prevent or to treat calcium deficiencies. It is not used to accelerate fetal lung maturity.
Choice D rationale
Betamethasone (Celestone) is a corticosteroid that is used to mature the lungs in fetuses at risk for preterm birth.
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