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A nurse is caring for a newborn who is large for gestational age and is 12 hours old.
Which of the following laboratory tests should the nurse monitor based on the client's condition?

A.

Bilirubin.

B.

Glucose.

C.

White blood cell count.

D.

Arterial blood gases.

Answer and Explanation

The Correct Answer is B

Choice A rationale

Bilirubin monitoring is critical for jaundice due to hemolysis, often seen in ABO incompatibility or cephalohematoma. While Large for Gestational Age (LGA) infants can have polycythemia, hypoglycemia is a more immediate and life-threatening risk that requires priority monitoring in the first hours of life. The normal total bilirubin range is typically less than 5 mg/dL in the first 24 hours.

Choice B rationale

LGA infants are often born to mothers with uncontrolled or gestational diabetes, leading to fetal hyperinsulinism. After birth, the maternal glucose supply is cut off, and the high insulin levels persist, causing a rapid and profound drop in the newborn's blood glucose, hence hypoglycemia is a major concern. The normal newborn glucose range is 40 to 60 mg/dL and should be monitored.

Choice C rationale

White blood cell (WBC) count is primarily monitored to detect neonatal sepsis or infection. While all newborns are at risk, the LGA classification does not inherently place them at a higher, unique risk for infection compared to the immediate metabolic derangement risks like hypoglycemia. The normal WBC count range is 9,000 to 30,000 cells/mm.

Choice D rationale

Arterial Blood Gases (ABGs) are used to assess the newborn's respiratory status and acid-base balance, particularly in respiratory distress syndrome or persistent pulmonary hypertension. While LGA infants can experience birth trauma or meconium aspiration, ABG monitoring is not routine unless significant respiratory symptoms are present.


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Related Questions

Correct Answer is A

Explanation

Choice A rationale

Soft grunting noises during expiration are a sign of mild to moderate respiratory distress in a newborn. Grunting is the newborn's attempt to keep the alveoli open by increasing Positive End-Expiratory Pressure (PEEP), suggesting decreased lung compliance or insufficient surfactant. This finding requires immediate notification of the provider for evaluation and potential intervention.

Choice B rationale

A positive Babinski reflex, which involves the great toe dorsiflexing and the other toes fanning out upon stroking the sole of the foot, is a normal neurological finding in a newborn and infant. This reflex persists until about 1 to 2 years of age as the central nervous system matures, and therefore does not require reporting.

Choice C rationale

Acrocyanosis, which is pale blue hands and feet with pinkish trunk and mucous membranes, is a common and normal finding in a newborn during the first 24 to 48 hours after birth due to immature peripheral circulation and cold exposure. This peripheral vasoconstriction resolves spontaneously and is not typically reported unless accompanied by central cyanosis.

Choice D rationale

Blood-tinged discharge from the vagina, often called pseudomenstruation, is a normal, transient finding in female newborns. It is caused by the withdrawal of maternal estrogen hormones following birth, leading to a minor sloughing of the uterine endometrium, and does not indicate a pathological condition requiring immediate reporting.

Correct Answer is {"A":{"answers":"C"},"B":{"answers":"C"},"C":{"answers":"C"},"D":{"answers":"C"},"E":{"answers":"C"},"F":{"answers":"B"}}

Explanation

Explanation

  1. Moderate maternal bleeding
    • In a patient with HELLP and thrombocytopenia, bleeding suggests coagulopathy (DIC) or placental abruption. This is a serious worsening sign.
  2. Ringing in ears (tinnitus)
    • Could be a side effect of magnesium sulfate toxicity or a neurological symptom of worsening preeclampsia. Either way, it’s concerning and not a sign of improvement.
  3. Sharp, stabbing abdominal pain
    • RUQ/epigastric pain worsening into sharp pain raises concern for liver capsule distension or rupture (life-threatening complication of HELLP) or placental abruption. This is a red flag.
  4. BP 180/100 mm Hg
    • Despite antihypertensive therapy, this is severe hypertension (≥160/110 mm Hg). Indicates poor control and worsening maternal risk.
  5. FHR 80/min with absent variability
    • This is severe fetal bradycardia with no variability, indicating fetal hypoxia/distress. This is an obstetric emergency.
  6. PT 12 seconds
    • Within normal range (11–13.5 sec). This suggests no current coagulopathy and is the only stable/improving finding.

Almost all findings point to worsening maternal and fetal condition, except for the PT which is stable. The nurse should immediately notify the provider, anticipate emergency delivery (likely induction or cesarean), and continue close monitoring for magnesium toxicity and bleeding complications.

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