A nurse is caring for a newborn immediately following birth.
For which of the following reasons should the nurse delay the instillation of antibiotic ophthalmic ointment?
The newborn weighs less than 2.5 kg (5.5 lb).
The newborn was delivered via cesarean birth.
To allow manifestations of infection to be identified.
To facilitate bonding between the newborn and parent.
The Correct Answer is D
Choice A rationale
The weight of the newborn is not a factor in the decision to delay the instillation of antibiotic ophthalmic ointment. The ointment is used to prevent eye infections caused by bacteria present in the mother’s birth canal, and this risk is not related to the newborn’s weight.
Choice B rationale
Whether the newborn was delivered via cesarean birth or vaginal birth does not affect the decision to delay the instillation of antibiotic ophthalmic ointment. The ointment is used to prevent eye infections that can occur regardless of the method of delivery.
Choice C rationale
While it is important to monitor newborns for signs of infection, delaying the instillation of antibiotic ophthalmic ointment would not aid in identifying manifestations of infection. The ointment is a preventative measure and does not interfere with the observation of symptoms.
Choice D rationale
Correct answer. The instillation of antibiotic ophthalmic ointment can cause blurred vision in the newborn. Delaying the instillation of the ointment facilitates immediate bonding between the newborn and parent, as the newborn will be able to see more clearly.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
An incompetent cervix is a condition that occurs when weak cervical tissue causes or contributes to premature birth or the loss of an otherwise healthy pregnancy. This condition is not directly related to the client’s current state of being 80% effaced and 8 cm dilated.
Choice B rationale
Hyperemesis gravidarum is a condition characterized by severe nausea, vomiting, weight loss, and electrolyte disturbance. Mild cases are treated with dietary changes, rest, and antacids.
More severe cases often require a stay in the hospital so that the mother can receive fluid and nutrition through an intravenous line. This condition is not directly related to the client’s current state of being 80% effaced and 8 cm dilated.
Choice C rationale
Postpartum hemorrhage is a condition that can occur due to a variety of factors, one of which is a rapid or prolonged labor, which can result in uterine atony. Given that the client is 80% effaced and 8 cm dilated, she is in active labor and could potentially be at risk for postpartum hemorrhage.
Choice D rationale
An ectopic pregnancy is a pregnancy in which the fertilized egg implants outside the uterus. The client is already in active labor, which means the pregnancy is not ectopic.
Correct Answer is D
Explanation
Choice A rationale
While a sleep sack can keep a baby warm, it should not be used in a car seat because it can interfere with the harness and affect its effectiveness.
Choice B rationale
A car seat challenge test is usually performed on premature babies or those with medical conditions. It is not routinely required for a newborn delivered at 38 weeks of gestation.
Choice C rationale
The American Academy of Pediatrics recommends that children remain in a rear-facing car seat until they reach the highest weight or height allowed by their car safety seat’s manufacturer, which is typically around 2 years of age.
Choice D rationale
The car seat should indeed be positioned at a 45-degree angle. This position helps to keep the baby’s airway open and protects them in the event of a crash.
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