A nurse is preparing to obtain a blood sample from a newborn’s heel. In what order should the nurse perform the procedure?

Clean the area with an antiseptic

Apply a warm cloth to the newborn’s heel for 5 to 10 minutes

Puncture the outer aspect of the newborn’s heel

Collect the blood specimen

Apply pressure to the site with a dry gauze pad

Answer and Explanation

The Correct Answer is B, A, C, D, E

Step 1 is to apply a warm cloth to the newborn’s heel for 5 to 10 minutes. Warming the heel improves blood flow to the area, making it easier to obtain a blood sample.

Step 2 is to clean the area with an antiseptic. This is to prevent infection.

Step 3 is to puncture the outer aspect of the newborn’s heel. The outer aspect of the heel is less sensitive and less likely to be injured by the lancet.

Step 4 is to collect the blood specimen. After the heel has been punctured, blood will start to flow out and can be collected.

Step 5 is to apply pressure to the site with a dry gauze pad. This is to stop the bleeding after the blood sample has been collected.

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Correct Answer is B

Explanation

Choice A rationale
The Plastibell is not removed 4 hours after the procedure. Instead, it remains on the penis until the foreskin falls off naturally in seven to 10 days.
Choice B rationale
Yellow exudate, which is a normal part of the healing process, will form at the surgical site within 24 hours after a Plastibell circumcision. Parents should be reassured that this is not a sign of infection.
Choice C rationale
The end of the baby’s penis may appear dark red immediately after the procedure, but this should improve within a few days. If the redness persists or worsens, parents should notify the provider.
Choice D rationale
Ensuring that the newborn’s diaper is snug is not specific to the Plastibell circumcision technique. While a snug diaper can help prevent leaks, it should not be so tight as to cause discomfort or restrict circulation.

A. Transient strabismus B. Mottling C. Respiratory rate of 70/min D. Loose stools E. Regurgitation

Correct Answer is C

Explanation

Choice A rationale
Transient strabismus, or temporary misalignment of the eyes, is not typically a symptom observed in newborns exposed to opioids during pregnancy.
Choice B rationale
Mottling, or patchy skin color, is a common physical characteristic in newborns and is not specifically associated with opioid exposure during pregnancy.
Choice C rationale
A respiratory rate of 70/min is significantly higher than the normal range for a newborn, which is typically between 30 and 60 breaths per minute. This could be a sign of neonatal abstinence syndrome (NAS), a group of conditions caused by withdrawal from certain drugs that the newborn was exposed to in the womb.
Choice D rationale
Loose stools are not typically associated with opioid exposure during pregnancy.
Choice E rationale
Regurgitation, or spitting up, is common in newborns and is not specifically associated with opioid exposure during pregnancy.

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A nurse is preparing to obtain a blood sample from a newborn’s heel. In what order should the nurse perform the procedure?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is educating the parents of a newborn about the Plastibell circumcision technique. Which piece of information should the nurse include in the teaching?

Correct Answer is B

Explanation

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Correct Answer is C

Explanation

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