A nurse is caring for a newborn who was born prematurely.

Which finding should the nurse report as a potential complication of prematurity?

Decreased bilirubin levels

Increased fat stores

Hypoglycemia due to low glycogen stores

Presence of mature lung surfactant

Answer and Explanation

The Correct Answer is C

Hypoglycemia due to low glycogen stores.

Premature newborns have low glycogen stores and are at risk of developing hypoglycemia, which can cause seizures, brain damage, or death.

The nurse should monitor the blood glucose levels of the newborn and report any signs of hypoglycemia, such as jitteriness, lethargy, poor feeding, or temperature instability.

Choice A is wrong because increased bilirubin levels, not decreased, are a potential complication of prematurity.

Bilirubin is a waste product of red blood cell breakdown that can accumulate in the blood and cause jaundice, a yellowing of the skin and eyes.

Premature newborns have immature livers that cannot process bilirubin effectively and may need phototherapy to reduce the levels.

Choice B is wrong because decreased fat stores, not increased, are a potential complication of prematurity.

Fat stores provide insulation and energy for the newborn and help maintain body temperature.

Premature newborns have less subcutaneous fat and are prone to heat loss and cold stress, which can affect their metabolism and oxygen consumption.

Choice D is wrong because absence of mature lung surfactant, not presence, is a potential complication of prematurity.

Surfactant is a substance that reduces the surface tension of the alveoli and prevents them from collapsing during expiration.

Premature newborns have insufficient surfactant production and may develop respiratory distress syndrome, which is characterized by tachypnea, grunting, retractions, and cyanosis.

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Correct Answer is B

Explanation

Administering tocolytics.Tocolytics are drugs that inhibit uterine contractions and can delay preterm labor for a short time.This can allow time for the administration of corticosteroids and transfer to a tertiary care facility if necessary.

Choice A is wrong because administering intravenous fluids does not reduce uterine activity.It may be used to correct dehydration or electrolyte imbalance, which can be risk factors for preterm labor.

Choice C is wrong because administering corticosteroids does not reduce uterine activity.It may be used to enhance fetal lung maturity and reduce the risk of neonatal complications such as respiratory distress syndrome, intracranial hemorrhage, and necrotizing enterocolitis.

Choice D is wrong because administering antibiotics does not reduce uterine activity.It may be used to treat infections that can trigger preterm labor, such as bacterial vaginosis or chorioamnionitis.

A. Encouraging early ambulation B. Administering medications to induce hypercoagulability C. Monitoring the client's blood glucose levels D. Maintaining a neutral head position

Correct Answer is D

Explanation

Maintaining a neutral head position.This action can help reduce the client’s risk of intraventricular hemorrhage (IVH) by preventing fluctuations in intracranial pressure that could rupture blood vessels in the brain.

Choice A is wrong because encouraging early ambulation can increase the risk of IVH by causing changes in blood pressure and cerebral perfusion.

Choice B is wrong because administering medications to induce hypercoagulability can increase the risk of IVH by promoting thrombosis and impairing blood flow to the brain.

Choice C is wrong because monitoring the client’s blood glucose levels is not directly related to the prevention of IVH, although it may be important for other reasons such as avoiding hypoglycemia or hyperglycemia.

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A nurse is caring for a newborn who was born prematurely. Which finding should the nurse report as a potential complication of prematurity?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client at 32 weeks of gestation is diagnosed with pre-term labor. Which intervention should the nurse prioritize to reduce uterine activity?

Correct Answer is B

Explanation

A nurse is caring for a client who is at risk for developing intraventricular hemorrhage (IVH). Which action should the nurse take to reduce the client's risk?

Correct Answer is D

Explanation

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A nurse is performing a physical examination on a client who is at 30 weeks of gestation and has pre-term labor. Which of the following findings indicates fetal distress?

A nurse is caring for a newborn who was born prematurely.

Which finding should the nurse report as a potential complication of prematurity?