A nurse is preparing to collect a specimen for newborn screening. Which of the following actions should the nurse take?
Use a lancet to puncture the inner aspect of the newborn's heel.
Leave the newborn's heel open to the air after the puncture.
Apply an antiseptic to the newborn's heel after collecting the specimen.
Warm the newborn's heel for 5 to 10 min before the puncture.
The Correct Answer is A
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A) Incorrect- A reddened area on the calf might indicate a potential blood clot (deep vein thrombosis), which is important to assess but may not be the highest priority.
B) Incorrect- Painful uterine contractions during breastfeeding can be a normal response due to oxytocin release during breastfeeding and might not require immediate reporting.
C) Correct - A urinary output of 125 mL in 4 hours is significantly low and could indicate inadequate fluid intake, potential urinary retention, or other issues that need prompt attention. It is a sign of impaired renal function. This could indicate dehydration, blood loss, infection, or kidney injury. The nurse should assess the client's fluid intake and output, vital signs, urine specific gravity, and serum electrolyte levels. The nurse should also monitor the client for signs of hypovolemia, such as tachycardia, hypotension, and decreased skin turgor.
D) Incorrect- Changing a perineal pad every 2 hours is within the normal range for postpartum bleeding and might not require immediate reporting.
Correct Answer is D
Explanation
A) Incorrect- Having a high-fat snack before bed might exacerbate nausea. It's generally recommended to have a light snack if needed.
B) Incorrect- Eating small, frequent snacks between meals can help manage nausea by preventing an empty stomach.
C) Incorrect- Drinking water with meals might not necessarily help with nausea and might worsen the feeling of fullness.
D) Correct - "Eat a slice of dry toast before getting out of bed" can help alleviate morning sickness in the first trimester. Eating a small, bland snack before rising can prevent an empty stomach, which can contribute to nausea.
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