A nurse is planning care for a newborn who has spinal bifida. Which of the following actions should be included in the plan of care?
Obtain rectal temperatures.
Cover the lesion with a dry dressing
Apply snug, clean diapers.
Place the newborn in the prone position.
The Correct Answer is D
The newborn should be placed in prone position to prevent pressure to the lesion which may lead to damage to the contents of the sac. It should be covered with a sterile, wet gauze to maintain the integrity of the sac.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A. Early decelerations are usually benign and are associated with head compression during contractions.
B. Accelerations are increases in the fetal heart rate above the baseline. They are typically reassuring and indicate fetal well-being.
C. Late decelerations are concerning patterns in fetal heart rate monitoring. They can indicate poor oxygenation of the fetus and may be associated with conditions such as maternal hypotension, placental insufficiency, or other factors compromising blood flow to the fetus.
D. Variable decelerations are abrupt decreases in fetal heart rate that vary in timing, duration, and depth. They are often associated with umbilical cord compression, such as when the cord is being compressed or squeezed during contractions.
Correct Answer is D
Explanation
Drying the newborn's skin helps prevent heat loss through evaporation, which is crucial for maintaining the newborn's body temperature and preventing hypothermia. Administering vitamin K, eye prophylaxis, and placing an identification bracelet are important aspects of newborn care but not priority.
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