A nurse receives a mother and baby in postpartum. The baby is approximately 2 hours old. During the assessment of the baby the nurse recognizes the following symptoms of transient tachypnea of the newborn except for-
Heartrate of 170
Grunting or singing with respirations
Nasal flaring
Respirations of 72
The Correct Answer is A
Rationale
Transient tachypnea of the newborn (TTN) is a condition characterized by rapid breathing shortly after birth. Common symptoms of TTN include grunting or sighing with respirations, nasal flaring, and respiratory rates higher than normal.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
A pink rash appearing on the newborn's trunk while receiving phototherapy may indicate a potential adverse reaction to the treatment, such as a phototoxic reaction or erythema. This finding should be promptly assessed by the nurse as it may indicate skin irritation or sensitivity to the phototherapy.
A. The mother applying lotion to the newborn's skin is generally not contraindicated during phototherapy,
B. Covering the newborn's eyes with a mask is a standard practice during phototherapy to protect the eyes from exposure to the light, and it does not typically require intervention.
C. An increase in the number of newborn's stools is a common side effect of phototherapy and is not typically concerning unless accompanied by other symptoms such as diarrhea or dehydration.
Correct Answer is B
Explanation
53. A nurse is caring for a client who has a suspected ectopic pregnancy at 8 weeks of gestation. An ectopic pregnancy occurs when the fertilized egg implants outside the uterus, most commonly in the fallopian tube. One of the hallmark symptoms of an ectopic pregnancy is unilateral, cramp-like abdominal pain depending on the location of the pregnancy.
A. Uterine enlargement greater than expected for gestational age is not expected in an ectopic pregnancy because the fertilized egg implants outside the uterus, so there is no uterine enlargement.
C. Severe nausea and vomiting are more commonly associated with conditions such as hyperemesis gravidarum or early pregnancy symptoms but are not specific to ectopic pregnancy.
D. A large amount of vaginal bleeding may occur in some cases of ectopic pregnancy, but it is not a consistent or defining characteristic.
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