A nurse is caring for a newborn who is formula-fed. The newborn takes 0.5 oz of formula at 0800, 1 oz at 1100, 0.5 oz at 1300, 0.5 oz at 1600, and 0.5 oz at 1830. How many mL of formula should the nurse record as the client's intake for the shift?
15 mL.
30 mL.
45 mL.
60 mL.
The Correct Answer is D
Choice A rationale:
15 mL is not the correct choice because it only considers the first two feedings and does not account for the intake during the entire shift.
Choice B rationale:
30 mL is not the correct choice because it only considers the first three feedings and does not account for the intake during the entire shift.
Choice C rationale:
45 mL is not the correct choice because it only considers the first four feedings and does not account for the intake during the entire shift.
Choice D rationale:
The nurse should record 60 mL of formula as the newborn's intake for the shift. To calculate the total intake, you add the amounts from each feeding: 0.5 oz + 1 oz + 0.5 oz + 0.5 oz + 0.5 oz = 60 mL. Remember that 1 fluid ounce (oz) is approximately equal to 30 mL.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
"Baby powder will help prevent a diaper rash.”.
Choice A rationale:
"I will use mild soap”. indicates an appropriate understanding of newborn bathing. Mild soap is suitable for newborn skin to avoid irritation.
Choice B rationale:
This is the correct answer. Baby powder is not recommended for newborns as it can cause respiratory issues when inhaled and may lead to skin irritation. Therefore, the client needs further teaching about the use of baby powder.
Choice C rationale:
"I will test the water on my wrist for temperature before bathing”. demonstrates proper safety measures, ensuring the water is not too hot for the baby.
Choice D rationale:
"I will use a basin during bathing”. is a reasonable approach to bathing the newborn and does not indicate a need for further teaching.
Correct Answer is ["A","D"]
Explanation
Choice A rationale:
Respiratory distress is a priority assessment finding that indicates a newborn may be experiencing cold stress. Cold stress can cause the baby's body to burn brown fat to generate heat, leading to increased oxygen demand and respiratory distress as a compensatory mechanism.
Choice B rationale:
Hyperglycemia is not associated with cold stress. Instead, hypoglycemia (low blood sugar) is a concern in newborns experiencing cold stress as they deplete their glucose stores to maintain body temperature.
Choice C rationale:
Metabolic alkalosis is not a priority assessment finding for cold stress. Metabolic acidosis (not listed in the options) can be associated with cold stress due to increased anaerobic metabolism, but it is not one of the provided choices.
Choice D rationale:
Hypoglycemia is a priority assessment finding associated with cold stress. As the baby's body uses glucose to produce heat from burning brown fat, it can lead to a drop in blood sugar levels, which is a significant concern in newborns.
Choice E rationale:
Metabolic acidosis is not listed among the provided choices, but it can be associated with cold stress due to the increased production of lactic acid from anaerobic metabolism when trying to generate heat.
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