A nurse is caring for a newborn whose mother has gestational diabetes. The newborn has a blood glucose level of 30 mg/dL and is asymptomatic. Which of the following actions should the nurse take?

Check urine for ketones.

Administer glucagon

Encourage an additional feeding.

Recheck blood glucose in 4 hr.

Answer and Explanation

The Correct Answer is C

A)   Incorrect- Checking urine for ketones is not necessary if the newborn's blood glucose level is low but stable and the baby is asymptomatic.
B)   Incorrect- Administering glucagon is not indicated for an asymptomatic newborn with a low but stable blood glucose level.
C)   Correct - Encouraging additional feeding is appropriate for an asymptomatic newborn with a low blood glucose level. Regular feeding can help increase blood glucose levels.
D)   Incorrect- Waiting 4 hours to recheck blood glucose might not be appropriate if the baby's blood glucose is currently low. Addressing the low blood glucose level is more immediate.

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Correct Answer is B

Explanation

A) Incorrect- Foul-smelling vaginal discharge might indicate infection but is not the priority over the presence of meconium-stained amniotic fluid.
B) Correct- Fetal heart rate is important to monitor, but the presence of meconium- stained amniotic fluid has higher priority. fetal heart tones 98/min, because this indicates fetal distress and requires immediate intervention.
C) Incorrect - Amniotic fluid with meconium noted could indicate fetal hypoxia or distress, but it is not always a sign of a problem and depends on other factors such as gestational age and fetal activity.
D) Incorrect- Maternal temperature elevation might indicate infection but is not the priority over assessing the condition of the amniotic fluid and the baby.

A. Encourage the client to perform Kegel exercises. B. Administer ibuprofen to the client. C. Apply a cool compress to the client's abdomen. D. Place the client in a side-lying position.

Correct Answer is B

Explanation

A) Incorrect- Kegel exercises are helpful for strengthening pelvic floor muscles but may not directly alleviate afterpains.
B) Correct - Afterpains are uterine contractions that occur after childbirth and can be uncomfortable, especially during breastfeeding. Ibuprofen is often used to relieve this discomfort.
C) Incorrect- Applying a cool compress might provide some relief, but pain relief medications like ibuprofen are more effective for afterpains.
D) Incorrect- While a side-lying position can be comfortable for breastfeeding, it may not directly address the afterpains.

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A nurse is caring for a newborn whose mother has gestational diabetes. The newborn has a blood glucose level of 30 mg/dL and is asymptomatic. Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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