A nurse is caring for a newborn.
Drag words from the choices below to fill in each blank in the following sentence.
The client is at risk for developing
The Correct Answer is {"dropdown-group-1":"D","dropdown-group-2":"A"}
The client is at risk for developing transient tachypnea of the newborn and hypoglycemia.
Rationale:
Target 1: Transient Tachypnea of the Newborn (TTN): The newborn has progressively increasing respiratory rates (68 → 72 → 76 breaths/min) along with grunting and mild intercostal retractions. Cesarean birth is a major risk factor for TTN because the absence of labor contractions delays the clearance of fetal lung fluid. TTN typically presents within the first few hours of life with tachypnea and mild respiratory distress, resolving within 24–72 hours.
Target 2: Hypoglycemia: The newborn weighs 4200 g (9 lb 4 oz), indicating macrosomia.
Large-for-gestational-age (LGA) infants are at higher risk for hypoglycemia due to increased insulin production in response to maternal hyperglycemia. Tachypnea can also be a sign of hypoglycemia in neonates.
Incorrect Options:
Tachycardia: The newborn’s heart rate is elevated (154–156 bpm), but mild tachycardia is expected in newborns and is not the primary concern compared to respiratory distress and hypoglycemia risk.
Bronchopulmonary Dysplasia (BPD): BPD is a chronic lung condition primarily seen in preterm infants who require prolonged mechanical ventilation and oxygen therapy. This newborn was term, had clear amniotic fluid, and no intubation, making BPD unlikely.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Limiting potassium intake is incorrect because hypokalemia increases the risk of digoxin toxicity.
B. If the child vomits after taking digoxin, the dose should NOT be repeated, as it may be due to toxicity.
C. Digoxin should NOT be mixed with large amounts of liquid, as the child may not finish it, leading to an incomplete dose.
D. Drinking water helps remove residual digoxin from the mouth, preventing irritation and ensuring the full dose is swallowed.
Correct Answer is C
Explanation
A. Smacking lips is associated with tardive dyskinesia, not pseudoparkinsonism.
B. Serpentine (writhing) limb movement is characteristic of chorea or tardive dyskinesia, not pseudoparkinsonism.
C. Pseudoparkinsonism is an extrapyramidal side effect (EPS) of antipsychotics like haloperidol. It mimics Parkinson's disease and includes shuffling gait, muscle rigidity, tremors, and bradykinesia.
D. Nonreactive pupils are not a symptom of pseudoparkinsonism.
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