A nurse is caring for a newborn immediately following birth who has a prescription for erythromycin ophthalmic ointment.
The guardian refuses the medication. Which action should the nurse take?
Document the guardian’s refusal of the medication.
Inform the guardian that the medication can be given after discharge.
Report the guardian’s refusal of the medication to social services.
Notify the facility’s ethics committee about the guardian’s medication refusal.
The Correct Answer is A
Choice A rationale
Erythromycin ophthalmic ointment is administered to newborns to prevent neonatal conjunctivitis, also known as ophthalmia neonatorum, specifically for Neisseria gonorrhoeae infection prevention. If the guardian refuses the administration of erythromycin, the healthcare provider should respect the guardian’s decision and document the refusal. It’s important to note that the refusal should be informed, meaning the guardian should understand the potential risks associated with not administering the medication.
Choice B rationale
Informing the guardian that the medication can be given after discharge may not be the best course of action. The purpose of the ointment is to prevent infection immediately after birth when the risk is highest. Delaying the administration could potentially increase the risk of the newborn developing an infection.
Choice C rationale
Reporting the guardian’s refusal of the medication to social services is not the first step unless there are other concerns about the safety or well-being of the child. The healthcare provider should respect the guardian’s autonomy and their right to make informed decisions about the newborn’s care.
Choice D rationale
Notifying the facility’s ethics committee about the guardian’s medication refusal is not typically necessary unless the refusal puts the newborn at significant risk and other attempts to resolve the situation have failed. In this case, the refusal of erythromycin ophthalmic ointment, while not ideal, is not likely to warrant an ethics consultation.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
The Plastibell is not removed 4 hours after the procedure. Instead, it remains on the penis until the foreskin falls off naturally in seven to 10 days.
Choice B rationale
Yellow exudate, which is a normal part of the healing process, will form at the surgical site within 24 hours after a Plastibell circumcision. Parents should be reassured that this is not a sign of infection.
Choice C rationale
The end of the baby’s penis may appear dark red immediately after the procedure, but this should improve within a few days. If the redness persists or worsens, parents should notify the provider.
Choice D rationale
Ensuring that the newborn’s diaper is snug is not specific to the Plastibell circumcision technique. While a snug diaper can help prevent leaks, it should not be so tight as to cause discomfort or restrict circulation.
Correct Answer is A
Explanation
Choice A rationale
Administering oxygen helps improve oxygenation to the fetus and is the priority intervention for late decelerations. Oxytocin is commonly used for induction and augmentation of labor. Its influence is indirect via increased uterine activity, mostly due to increased frequency of contractions or baseline pressure (hypertonus). Increase in duration or amplitude of contractions can also lead to FHR changes. The FHR changes associated with oxytocin infusion may be caused by compression of the cord with contractions or by the reduction in placental perfusion due to increased intrauterine basal pressure and frequent contractions cutting off the blood supply to the placenta. Therefore, administering oxygen can help improve the oxygen supply to the fetus.
Choice B rationale
Instructing the client to bear down and push with contractions is not the appropriate action when the fetus is experiencing persistent late decelerations. This action is more associated with the active phase of labor and not with managing fetal distress.
Choice C rationale
Amnioinfusion is a procedure where a saline solution is instilled into the uterus during labor if there is low amniotic fluid, or thick meconium is present. It is not typically used in response to late decelerations in the FHR.
Choice D rationale
Placing the client in a supine position is not the correct action. The supine position can exacerbate a condition known as supine hypotensive syndrome, where the gravid uterus compresses the inferior vena cava, reducing venous return to the heart and cardiac output. This can potentially worsen fetal distress.
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