A nurse is caring for a newborn who is 5 days old.
The mother used opioids prior to pregnancy and was prescribed methadone during pregnancy. Both the mother and the newborn tested positive for methadone in their urine drug screens.
The newborn is exhibiting clinical findings of neonatal abstinence syndrome (NAS). Which of the following actions should the nurse take? Select all that apply.
Maintain a low stimulation environment
Weigh the newborn daily
Advise the parent to avoid breastfeeding
Avoid eye contact with the newborn during feeding
Plan to administer naloxone
Swaddle the newborn with flexed extremities
Perform Ballard newborn screening each shift . .
Correct Answer : A,B,F
Choice A rationale
Maintaining a low-stimulation environment is recommended for newborns exhibiting clinical findings of NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice B rationale
Weighing the newborn daily is important in the care of a newborn with NAS56. This can help to monitor the newborn’s growth and development, and any significant changes in weight could indicate a need for further medical intervention.
Choice C rationale
Advising the parent to avoid breastfeeding is not typically recommended for mothers who used opioids prior to pregnancy and were prescribed methadone during pregnancy. In fact, breastfeeding is often encouraged for these mothers, as it can help to reduce the severity of NAS symptoms in the newborn.
Choice D rationale
Avoiding eye contact with the newborn during feeding is not typically recommended as part of the care for a newborn with NAS56. Eye contact can help to promote bonding between the parent and the newborn.
Choice E rationale
The administration of naloxone is not typically recommended for a newborn with NAS56. Naloxone is a medication used to reverse the effects of opioids, but it is not typically used in the treatment of NAS56.
Choice F rationale
Swaddling the newborn with flexed extremities can help to comfort a newborn with NAS56. This can help to reduce symptoms such as irritability and restlessness.
Choice G rationale
This option is not typically necessary for the management of neonatal abstinence syndrome (NAS). The Ballard score is used to assess gestational age and physical maturity of a newborn, but it is not a routine part of monitoring for NAS.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
A score of 9 on the Edinburgh Postnatal Depression Screen (EPDS) on postpartum day 2 is below the clinical cutoff score of 10, which is used to distinguish health controls versus possible depression. Therefore, this score would not indicate a high risk of developing a depressive disorder.
Choice B rationale
A score of 11 on the EPDS on postpartum day 30 is above the clinical cutoff score of 1034. This score indicates a high risk of developing a depressive disorder. Therefore, further assessment and possible intervention would be necessary.
Choice C rationale
While discharge teaching is an important aspect of postpartum care, it does not provide information about the client’s risk of developing postpartum depression. Therefore, this choice does not answer the question.
Choice D rationale
A follow-up appointment with a provider in 4 weeks is a standard part of postpartum care, but it does not provide information about the client’s risk of developing postpartum depression.
Therefore, this choice does not answer the question.
Correct Answer is ["A","D"]
Explanation
Choice A rationale
Vacuum-assisted delivery is indeed a risk factor for postpartum hemorrhage. This method of delivery can cause trauma to the birth canal, which can lead to increased bleeding after delivery.
Choice B rationale
A history of human papillomavirus (HPV) is not typically associated with an increased risk of postpartum hemorrhage.
Choice C rationale
The newborn’s weight, whether high or low, is not typically considered a risk factor for postpartum hemorrhage.
Choice D rationale
Labor induction with oxytocin is a risk factor for postpartum hemorrhage. Oxytocin is a drug that can cause the uterus to contract too much, leading to uterine atony (a condition where the uterus doesn’t contract properly after birth), which can result in postpartum hemorrhage.
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