A nurse is collecting data from a term newborn who is 12 hr old. Which of the following findings should the nurse report to the provider?

Abdominal breathing

Grunting

Respiratory rate 55/min

Irregular respirations

Answer and Explanation

The Correct Answer is B

A)   Incorrect- Abdominal breathing is a normal pattern in newborns and does not require immediate reporting.
B)   Correct - Grunting is a sign of respiratory distress in a newborn and should be reported to the provider for further evaluation.
C)   Incorrect- A respiratory rate of 55/min is within the normal range for a newborn and does not require immediate reporting.
D)   Incorrect- Irregular respirations are common in newborns and may not necessarily be indicative of a problem.

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Correct Answer is B

Explanation

A) Incorrect- Elevating a baby's head with a cushion during sleep is not recommended, as it can increase the risk of sudden infant death syndrome (SIDS) and obstructed breathing.
B) Correct - "I should replace the batteries in my smoke detector twice per year." Regularly replacing smoke detector batteries helps ensure they function properly in case of a fire emergency.
C) Incorrect- Setting the hot water heater to 130°F (54.4°C) is too hot and can cause scalding burns. The recommended temperature is 120°F (48.9°C) or lower.
D) Incorrect- Baby powder is not recommended for use with diaper changes, as it can be inhaled by the baby and lead to respiratory issues.

A. Use a lancet to puncture the inner aspect of the newborn's heel. B. Leave the newborn's heel open to the air after the puncture. C. Apply an antiseptic to the newborn's heel after collecting the specimen. D. Warm the newborn's heel for 5 to 10 min before the puncture.

Correct Answer is A

Explanation

A) Correct - Newborn screening typically involves a heel stick using a lancet to collect a few drops of blood from the inner aspect of the newborn's heel.
B) Incorrect- Leaving the newborn's heel open to the air after the puncture is not necessary; a small bandage is typically applied.
C) Incorrect- An antiseptic is not typically applied after collecting the specimen, as it could interfere with the accuracy of the screening tests.
D) Incorrect- Warming the newborn's heel is not a standard step before collecting a specimen for newborn screening.

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A nurse is collecting data from a term newborn who is 12 hr old. Which of the following findings should the nurse report to the provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is A

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