A nurse is planning care for a pre-term newborn who has a diagnosis of intraventricular hemorrhage (IVH).
Which of the following interventions should the nurse include in the plan?
Monitor vital signs and neurological status frequently
Administer antibiotics as prescribed
Elevate the head of the bed to 30 degrees
Provide supplemental oxygen as needed
The Correct Answer is A
Monitor vital signs and neurological status frequently.
This is because intraventricular hemorrhage (IVH) is a common and serious complication of prematurity that can lead to hydrocephalus, cerebral palsy, and developmental delays. Monitoring vital signs and neurological status can help detect changes in intracranial pressure, bleeding, and infection.
Choice B is wrong because antibiotics are not indicated for IVH unless there is evidence of infection.
Choice C is wrong because elevating the head of the bed to 30 degrees can increase the risk of IVH by reducing cerebral perfusion pressure and causing venous congestion.
Choice D is wrong because supplemental oxygen is not recommended for IVH unless there is hypoxia or respiratory distress. Excessive oxygen can cause oxidative stress and vasoconstriction, which can worsen IVH.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
According to the search results, magnesium sulfate can have a negative effect on the fetal heart rate (FHR) by lowering the baseline, decreasing the variability, and reducing the reactivity or acceleration pattern.Absent variability means that there is no fluctuation in the FHR and it indicates fetal hypoxia or acidosis.
This is a potential adverse effect of magnesium sulfate on the fetus and requires immediate intervention.
Choice A.Accelerations is wrong because accelerations are transient increases in the FHR that indicate fetal well-being.They are not affected by magnesium sulfate.
Choice B.Early decelerations is wrong because early decelerations are decreases in the FHR that occur with uterine contractions and are caused by fetal head compression.They are benign and do not indicate fetal distress.They are not associated with magnesium sulfate.
Choice C.Variable decelerations is wrong because variable decelerations are abrupt decreases in the FHR that vary in shape, duration, and timing and are caused by umbilical cord compression.
They may or may not indicate fetal compromise.
Correct Answer is A
Explanation
Amniotic fluid index of 4 cm indicates oligohydramnios, which means too little amniotic fluid.This can cause fetal growth restriction, cord compression, and congenital anomalies.
Choice B is wrong because amniotic fluid index of 8 cm is within the normal range of 5 to 25 cm.
Choice C is wrong because amniotic fluid index of 12 cm is also within the normal range and close to the median value of 14 cm.
Choice D is wrong because amniotic fluid index of 16 cm is also within the normal range and does not indicate oligohydramnios.
Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.
Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today
Report Wrong Answer on the Current Question
Do you disagree with the answer? If yes, what is your expected answer? Explain.
Kindly be descriptive with the issue you are facing.