A nurse is caring for a newborn who has exstrophy of the bladder.
Which of the following actions should the nurse take prior to the beginning of surgical correction?
Restrict the newborn's fluid intake.
Keep the newborn in a side-lying position.
Cover the newborn's bladder with a sterile, non-adherent dressing.
Exert gentle pressure on the newborn's bladder with sterile gauze.
Exert gentle pressure on the newborn's bladder with sterile gauze.
The Correct Answer is C
A nurse caring for a newborn who has exstrophy of the bladder should cover the newborn’s bladder with a sterile, non-adherent dressing prior to the beginning of surgical correction.
Choice A is incorrect because it is not necessary to restrict the newborn’s fluid intake.
Choice B is incorrect because it is not necessary to keep the newborn in a side- lying position.
Choice D is incorrect because it is not appropriate to exert gentle pressure on
the newborn’s bladder with sterile gauze.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
“Use an automatic puncture device on the heel.” This is the most common and minimally invasive method to draw capillary blood from an infant for medical testing.
Choice A is incorrect because the heel should be punctured on the outer aspect of the foot to avoid damaging the calcaneus bone.
Choice C is incorrect because the heel should be cleansed with an alcohol swab
before, not after, the procedure.
Choice D is incorrect because there is no need to place an ice pack on the newborn’s heel before the procedure.
Correct Answer is B
Explanation
The correct answer is. Administering broad-spectrum antibiotics.
Cleansing the site with povidone-iodine is not recommended because it can be irritating and potentially harmful to the exposed neural tissue.
Monitoring the rectal temperature every 4 hours is not appropriate as it can increase the risk of infection and trauma to the site. Axillary temperature monitoring is preferred.
Preparing for surgical closure after 72 hours is incorrect. Surgical closure is typically performed within the first 24 to 48 hours to prevent infection and further damage to the neural tissue.
Administering broad-spectrum antibiotics is crucial to prevent infection, especially since the cerebrospinal fluid is leaking, which increases the risk of meningitis and other infections.
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