A nurse is collecting data from a newborn who weighs 5,160 g (11 lb, 6 oz) and whose mother has diabetes mellitus. For which of the following data should the nurse monitor?

Hypercalcemia.

Hypobilirubinemia.

Hypoglycemia.

Decreased RBC.

Answer and Explanation

The Correct Answer is C

Choice A rationale :

Hypercalcemia - The nurse does not need to monitor for hypercalcemia in this scenario. Hypercalcemia refers to high levels of calcium in the blood, and it is not directly related to the newborn's weight or the mother's diabetes mellitus.

Choice B rationale

Hypobilirubinemia - Hypobilirubinemia is low levels of bilirubin in the blood and is not a major concern for a newborn's weight or the mother's diabetes mellitus. Although jaundice (high bilirubin levels) can be a concern in newborns, it is not the focus in this case.

Choice C rationale

Hypoglycemia - This is the correct choice. Newborns of diabetic mothers are at risk of developing hypoglycemia, which is low blood sugar levels. The baby receives excess glucose from the mother during pregnancy, and after birth, insulin production may be higher than needed, leading to low blood sugar levels. Monitoring for hypoglycemia is crucial to prevent potential complications.

Choice D rationale

Decreased RBC - The nurse does not need to monitor for decreased red blood cells (RBC) specifically related to the newborn's weight or the mother's diabetes mellitus. Monitoring RBC levels is important for other conditions, but it is not the primary concern in this case.

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Correct Answer is D

Explanation

The correct answer is choice d. Vastus lateralis.

Choice A rationale:

The deltoid muscle is not typically used for newborn injections because it is too small and underdeveloped, making it an inappropriate site for intramuscular injections in this age group.

Choice B rationale:

The dorsogluteal muscle is also not recommended for newborns due to the risk of injury to the sciatic nerve and the muscle’s underdevelopment.

Choice C rationale:

The ventrogluteal muscle, while a good site for older children and adults, is not commonly used for newborns because it is not as easily accessible and developed as the vastus lateralis.

Choice D rationale:

The vastus lateralis muscle, located on the anterolateral aspect of the thigh, is the preferred site for intramuscular injections in newborns. It is well-developed and provides a large muscle mass, making it the safest and most effective site for administering vitamin K.

A. Hypotension. B. Headache. C. Tachycardia. D. Polyuria.

Correct Answer is B

Explanation

Choice A rationale:

Hypotension is not an expected finding in a client with severe preeclampsia. In preeclampsia, the client typically experiences hypertension (high blood pressure) rather than hypotension (low blood pressure). Hypotension may be concerning as it could indicate inadequate perfusion to vital organs.

Choice B rationale:

Headache is an expected finding in a client with severe preeclampsia. Headaches are a common symptom of preeclampsia and are often described as persistent and severe. They can result from increased blood pressure and possibly cerebral oedema.

Choice C rationale:

Tachycardia is not an expected finding in a client with severe preeclampsia. Tachycardia refers to an abnormally fast heart rate, but in preeclampsia, bradycardia (abnormally slow heart rate) or a normal heart rate is more typical. Tachycardia could indicate other underlying issues.

Choice D rationale:

Polyuria is not an expected finding in a client with severe preeclampsia. Polyuria is characterized by excessive urination, and in preeclampsia, the opposite may occur due to decreased kidney perfusion, resulting in oliguria (reduced urine output).

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A nurse is collecting data from a newborn who weighs 5,160 g (11 lb, 6 oz) and whose mother has diabetes mellitus. For which of the following data should the nurse monitor?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer vitamin K IM to a newborn. Into which of the following muscles should the nurse inject the medication?

Correct Answer is D

Explanation

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Correct Answer is B

Explanation

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