A nurse is caring for a newborn who is 72 hr old.
Vital signs
0900:
- Heart rate 160/min
- Respiratory rate 80/min
- Temperature 38.1° C (100.6° F)
- Oxygen saturation 97%
1000:
- Heart rate 167/min
- Respiratory rate 72/min
- Temperature 38°C (100.4°F)
- Oxygen saturation 97%
Medical History
0900:
A term newborn 37 weeks of gestation is admitted to the newborn nursery following a precipitous vaginal birth. Birthing parent has a history of heroin use during pregnancy and prenatal care beginning at 34 weeks of gestation. Birthing parent and newborn drug screens positive for heroin.
The nurse is planning to contact the provider regarding the newborn's status. Which of the following prescriptions should the nurse anticipate? Select the 3 interventions the nurse should anticipate.
Administer oral morphine.
Swaddle the newborn.
Administer naloxone for NAS scores greater than 24.
Encourage the birthing parent to breastfeed.
Continue NAS scoring as prescribed
Correct Answer : A,B,E
A. Administering oral morphine is anticipated because it is used to manage withdrawal symptoms in newborns with Neonatal Abstinence Syndrome (NAS..
B. Swaddling is a non-pharmacological intervention that can provide comfort and reduce overstimulation.
C. Administering naloxone is not typically the first line of treatment for NAS and is used in cases of acute opioid overdose, which is not indicated by the information provided.
D. Encouraging the birthing parent to breastfeed may not be appropriate due to the presence of heroin in the system, which can be transmitted to the newborn through breast milk.
E. Continuing NAS scoring is essential to monitor the newborn's condition and response to treatment.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Rationale:
A. Metronidazole: Metronidazole is an antibiotic and does not have significant interactions with sildenafil.
B. Phenytoin: Phenytoin is an anticonvulsant medication and does not have significant interactions with sildenafil.
C. Prednisone: Prednisone is a corticosteroid and does not have significant interactions with sildenafil.
D. Isosorbide: Isosorbide is a nitrate medication used to treat angin
A. Combining sildenafil with nitrate medications can lead to severe hypotension and is contraindicated. Sildenafil potentiates the vasodilatory effects of nitrates, which can result in a dangerous drop in blood pressure.
Correct Answer is A
Explanation
Rationale:
A. This response acknowledges the client's concern and provides accurate information about the unpredictability of urinary frequency during pregnancy.
B. While some clients may experience relief from urinary frequency after the first trimester, it is not guaranteed, and poor bladder tone is just one of many factors that can contribute to urinary frequency during pregnancy.
C. This statement is inaccurate as urinary frequency can occur throughout pregnancy due to hormonal changes and pressure from the growing uterus.
D. Dismissing the client's concern as a minor inconvenience is not appropriate and does not address the client's question.
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