A nurse is caring for a newborn who requires a blood glucose test. Which of the following actions should the nurse take?
Apply a warm pack to the puncture site prior to the procedure.
Apply a mummy restraint to the newborn for the procedure.
Apply antiseptic solution to the puncture site after the procedure.
Elevate the extremity prior to the procedure.
The Correct Answer is A
A. Applying a warm pack to the puncture site before the procedure increases blood flow to the area, which makes the blood sample collection easier and reduces discomfort for the newborn.
B. A mummy restraint may not be necessary for a routine blood glucose test. The nurse can gently hold the newborn in place during the procedure without needing to fully restrain them.
C. Antiseptic solution is typically applied before the puncture to cleanse the area. After the procedure, gentle pressure and bandaging are more appropriate to stop bleeding.
D. Elevating the extremity is unnecessary for a newborn blood glucose test, as warming the area is more effective in promoting blood flow to the puncture site.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The newborn with blue hands and feet (acrocyanosis) along with a normal axillary temperature of 36.6°C (97.9°F) could indicate a need for further assessment. While acrocyanosis can be normal in newborns, it is essential to monitor for any signs of respiratory distress or circulatory issues. Since this newborn is exhibiting a potential sign of compromised circulation, this infant should be attended to first.
B. A newborn who has lost 12% of her birth weight is concerning, as significant weight loss in newborns can indicate feeding problems or other underlying issues. However, this would not take precedence over potential acute issues like those indicated in option A.
C. A newborn who is 24 hours post-circumcision with yellow exudate is expected to have some discharge as part of the healing process. If the exudate is not foul-smelling and there are no signs of infection, this is typically a normal finding.
D. A newborn with a blood glucose level of 63 mg/dL is within the normal range for newborns, as acceptable levels are typically above 40 mg/dL. Therefore, this does not require immediate attention.
Correct Answer is A
Explanation
- A) The normal range for hemoglobin (Hgb) in a full-term newborn is approximately 14 to 24 g/dL. A level of 9.5 g/dL is considered low and can indicate anemia, which may require further investigation and treatment.
- B) A platelet count of 225,000/mm³ is within the normal range for a full-term newborn, which typically falls between 150,000 to 450,000/mm³. Therefore, this value would not need to be reported.
- C) A glucose level of 60 mg/dL is within the normal range for a full-term newborn, which is typically 40 to 60 mg/dL shortly after birth. This level indicates that the newborn's glucose is being regulated properly.
- D) A white blood cell (WBC) count of 10,000/mm³ is within the normal range for a full-term newborn, which can range from 9,000 to 30,000/mm³. This suggests the absence of infection or inflammation.
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