A nursery nurse is attending the birth of a post-term infant
Fill in each blank in the following sentence.
Upon review of the medical record, the nurse should determine the infant newborn is at risk for developing
The Correct Answer is {"dropdown-group-1":"B","dropdown-group-2":"C"}
Rationale for correct choices:
- Macrosomia: Post-term infants (≥42 weeks gestation) have prolonged exposure to intrauterine nutrients, increasing the risk of excessive fetal growth. Macrosomia is common and can lead to complications such as shoulder dystocia or birth trauma.
- Meconium aspiration syndrome: As gestation progresses beyond term, placental function may decline, increasing fetal stress. This can trigger passage of meconium in utero and aspiration during delivery, especially with late decelerations suggesting uteroplacental insufficiency.
Rationale for incorrect choices:
- Intraventricular hemorrhage: This condition is typically associated with preterm infants due to fragile cerebral vasculature. A post-term newborn is not at increased risk for IVH.
- Bronchopulmonary dysplasia: BPD is a chronic lung disease most often seen in premature infants requiring prolonged mechanical ventilation and oxygen therapy. It is not a common concern for post-term infants.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Rationale:
A. Explain to the client they can change their mind at any time: Clients have the right to make or revoke decisions about resuscitation at any time. Informing the client of this autonomy supports informed consent and respects their evolving preferences and values regarding end-of-life care.
B. Obtain consent from the family for the change to the plan of care: The decision for a Do Not Resuscitate (DNR) order is made by the client, not the family, if the client is competent. Family involvement is supportive but does not override the client’s autonomy in this matter.
C. Discharge the client to hospice care: While hospice may be appropriate for end-stage disease, requesting a DNR does not automatically necessitate discharge. Clients can remain in the current care setting with appropriate adjustments to their goals of care.
D. Place a sign with "Do Not Resuscitate" outside the client's room: Displaying such signs can violate privacy and confidentiality. Instead, the DNR order should be documented clearly in the medical record and care plan, accessible to the healthcare team.
Correct Answer is D
Explanation
Rationale:
A. 42: A BMI of 42 falls in the category of class III (severe) obesity. This would only occur if the client's weight were significantly higher than 75 kg for a height of 1.8 m.
B. 28: A BMI of 28 indicates overweight status. At 75 kg and 1.8 m tall, the client does not meet the weight requirement for a BMI this high, as 28 would correspond to a weight closer to 91 kg.
C. 32: A BMI of 32 falls in the obesity range. For someone who is 1.8 m tall, a BMI of 32 would require a weight of about 104 kg, which is much higher than the client’s actual weight of 75 kg.
D. 24: The BMI is calculated as weight (kg) divided by height (m²). Using the formula:
BMI = 75 / (1.8 × 1.8) = 75 / 3.24 ≈ 23.15, which rounds to 24, placing the client in the normal weight range.
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