A nurse is caring for a newborn immediately following delivery. Which of the following actions should be the nurse's priority in the resuscitation of this neonate?
Administer phytonadione IM and erythromycin in both eyes
Document the Apgar score.
Apply identification bands.
Dry and stimulate the newborn: position and open the airway, clear secretions if necessary
The Correct Answer is D
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: Polyhydramnios is not a cause of variable decelerations. Polyhydramnios is a condition where there is an excessive amount of amniotic fluid, which can cause complications such as preterm labor, placental abruption, and cord prolapsE. Polyhydramnios can cause late decelerations, which are a sign of uteroplacental insufficiency and fetal hypoxiA.
Choice B: Fetal head compression is not a cause of variable decelerations. Fetal head compression is a normal physiological response to the uterine contractions and the descent of the fetal head into the pelvis. Fetal head compression can cause early decelerations, which are a benign and reassuring pattern that mirror the contractions.
Choice C: Umbilical cord compression is a cause of variable decelerations. Umbilical cord compression is a condition where the blood flow through the umbilical cord is reduced or interrupted, which can result from cord prolapse, cord knots, or cord wrapping around the fetal neck or limbs. Umbilical cord compression can cause variable decelerations, which are abrupt and irregular decreases in the FHR that vary in shape, duration, and timinG.
Choice D: Maternal fever is not a cause of variable decelerations. Maternal fever is a condition where the mother's body temperature is elevated, which can indicate an infection or inflammation. Maternal fever can cause tachycardia, which is a high FHR above the normal range of 110 to 160 beats/min.
Correct Answer is C
Explanation
A. "You are far enough along that your baby will be just finE." This is not a good response because it is dismissive of the client's concerns and does not provide any factual information or reassurancE. The nurse should not make false promises or minimize the client's feelings.
B. "Everyone worries about their baby while they are in labor." This is not a good response because it is generalizing and does not address the client's specific situation. The nurse should not compare the client to others or imply that their worries are normal or insignificant.
D. "We have a neonatal unit here equipped to handle emergencies." This is not a good response because it implies that there is a high risk of complications and may increase the client's anxiety. The nurse should not focus on negative outcomes or scare the client with unnecessary information.
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