A nurse is caring for an infant who has signs of neonatal abstinence syndrome. Which of the following actions should the nurse take?
Provide a stimulating environment
Monitor blood glucose level every hour
Initiate seizure precautions
Place the infant on his back with legs extended
The Correct Answer is C
Choice A rationale
Providing a stimulating environment is not recommended for infants with neonatal abstinence syndrome (NAS). These infants often have a heightened response to stimuli, and a calm, quiet environment is usually more beneficial.
Choice B rationale
While it is important to monitor the infant’s overall health, there is no specific need to monitor blood glucose level every hour in infants with NAS unless there is a separate medical indication.
Choice C rationale
Initiating seizure precautions is an appropriate action for a nurse caring for an infant with signs of NAS5. Infants with NAS are at risk for seizures, so nurses should be prepared to manage this potential complication.
Choice D rationale
Placing the infant on his back with legs extended is not recommended. Infants with NAS often have increased muscle tone and may be uncomfortable in this position.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A rationale
Jitteriness is a common sign of hypoglycemia in newborns. Newborns whose mothers had gestational diabetes are at an increased risk of developing hypoglycemia shortly after birth. Other signs of neonatal hypoglycemia can include poor feeding, lethargy, and seizures.
Choice B rationale
Increased muscle tone is not typically associated with hypoglycemia in newborns. However, decreased muscle tone can be a sign of severe hypoglycemia.
Choice C rationale
Abdominal distention is not typically associated with hypoglycemia in newborns. However, it can be a sign of other conditions, such as gastrointestinal obstruction or sepsis.
Choice D rationale
Petechiae, or small red or purple spots on the skin caused by bleeding into the skin, are not typically associated with hypoglycemia in newborns. However, they can be a sign of other conditions, such as infection or a bleeding disorder.
Correct Answer is C
Explanation
To calculate the estimated date of delivery using Nägele’s Rule, subtract three months from the first day of the last menstrual period (August 10), and then add seven days. This gives an estimated date of delivery of May 176.
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