A nurse is teaching the parents of a newborn about the critical congenital heart disease screening.
Which of the following statements should the nurse include in the teaching?
The test will be performed when your newborn is between 6 and 12 hours of age.
It will take 1 to 2 weeks to obtain the results of your newborn's test.
The test compares the oxygen saturation in your newborn's upper and lower extremities.
To perform the test, I will collect a blood sample from your newborn's heel.
The Correct Answer is C
Choice A rationale
The critical congenital heart disease (CCHD) screening is typically performed when the newborn is between 24 and 48 hours of age, or just prior to discharge if that occurs earlier. Performing the test too early, such as between 6 and 12 hours, might yield false negative results due to the persistence of transitional circulation.
Choice B rationale
The results of the CCHD screening are typically available immediately, or within a few minutes, as it involves pulse oximetry readings. There is no waiting period of 1 to 2 weeks for the results, allowing for prompt identification and management of potential cardiac defects, preventing delays in care.
Choice C rationale
The CCHD screening specifically compares the oxygen saturation in the newborn's right hand (pre-ductal) and either foot (post-ductal). A significant difference between these two readings can indicate a shunt or obstruction within the heart or great vessels, suggesting a potential critical congenital heart defect.
Choice D rationale
Collecting a blood sample from the newborn's heel is the procedure for the newborn metabolic screening, which screens for various genetic and metabolic disorders, not the critical congenital heart disease screening. The CCHD screening is a non-invasive test performed using pulse oximetry.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
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Correct Answer is D
Explanation
Choice A rationale
A hematocrit of 37% falls within the normal physiological range for a pregnant individual, which typically expands due to increased plasma volume. This hemodilution is a normal adaptive response to pregnancy, ensuring adequate perfusion to the placenta and fetal unit. This finding does not warrant reporting as it reflects a healthy maternal circulatory adjustment.
Choice B rationale
A creatinine level of 0.9 mg/dL is within the normal reference range for renal function in pregnant individuals. Glomerular filtration rate (GFR) increases during pregnancy, leading to a slight decrease in serum creatinine. This value indicates appropriate renal clearance and is not a cause for concern.
Choice C rationale
A WBC count of 11,000/mm³ is generally considered within the physiological elevation often seen during pregnancy, particularly in the second and third trimesters. This mild leukocytosis is an immunological adaptation, supporting the maternal immune response without indicating an infectious process or pathology that requires immediate reporting.
Choice D rationale
A fasting blood glucose of 180 mg/dL is significantly elevated above the normal range (74 to 106 mg/dL) and indicates hyperglycemia. This finding is highly suggestive of gestational diabetes mellitus, which can lead to adverse maternal and fetal outcomes if not managed. Therefore, it requires immediate reporting to the provider for further evaluation and intervention.
Correct Answer is D
Explanation
Choice A rationale
900 mL of urine output since birth (9 hours postpartum) translates to an average of 100 mL/hour. A normal urine output is typically 0.5 to 1 mL/kg/hour, which is usually greater than 30 mL/hour for adults. This indicates adequate renal perfusion and fluid balance rather than deficit.
Choice B rationale
A temperature of 37.6° C (99.6° F) is considered a low-grade fever. While it could be an early sign of infection, it is not a direct indicator of fluid volume deficit. Normal postpartum temperature may slightly increase due to dehydration or exertion during labor but usually remains below 38°C (100.4°F).
Choice C rationale
Reports of excessive sweating could be a compensatory mechanism for fever or a response to hormonal changes postpartum, but it is not a primary indicator of fluid volume deficit. In fact, excessive sweating can contribute to fluid loss, but it is not the most definitive sign.
Choice D rationale
A blood pressure of 80/55 mm Hg, particularly with a quantitative blood loss of 1200 mL, is a significant indicator of fluid volume deficit, specifically hypovolemic shock. Normal postpartum blood pressure is usually similar to pre-pregnancy levels (e.g., 90/60 to 120/80 mmHg). The low blood pressure reflects inadequate circulatory volume compromising tissue perfusion.
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