The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct?

Confirming that the newborn is at least 24 hours old.

Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration.

Assessing the dorsogluteal muscle as the preferred site for injection.

Confirming that the newborn's mother has been infected with the HBV.

Answer and Explanation

The Correct Answer is B

A. Confirming that the newborn is at least 24 hours old is not a requirement for administering the HBV vaccine. The vaccine can be given to newborns shortly after birth, typically within 12 hours.
B. Obtaining a syringe with a 25-gauge, 5/8-inch needle for medication administration is correct. This needle size is appropriate for administering vaccines intramuscularly to newborns.
C. Assessing the dorsogluteal muscle as the preferred site for injection is incorrect; the ventrogluteal or vastus lateralis muscles are recommended for intramuscular injections in infants. The dorsogluteal site is not preferred for young children due to the risk of sciatic nerve injury.
D. Confirming that the newborn's mother has been infected with the HBV is not necessary for administering the vaccine, although if the mother is infected, the newborn should receive the HBV vaccine and hepatitis B immunoglobulin (HBIG) within 12 hours of birth.

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Correct Answer is B

Explanation

A. Moderate bright red lochial flow on postpartum day 14 may indicate excessive bleeding and is not indicative of normal involution.
B. A fundus below the symphysis and nonpalpable suggests a well-contracted uterus, which is indicative of normal involution.
C. An episiotomy that is slightly red and puffy on day 14 may indicate ongoing healing, but it is not a direct measure of uterine involution.
D. Breasts that are firm and tender on postpartum day 14 may indicate engorgement, but they are not directly related to uterine involution.

A. Allow the newborn to continue crying. B. Keep the newborn in the center of a large crib. C. Carry the newborn evert time he/she cries. D. Swaddle the newborn in a receiving blanket.

Correct Answer is D

Explanation

A. Allowing the newborn to continue crying without attempting to soothe the baby is not an appropriate strategy for responsive parenting.
B. Keeping the newborn in the center of a large crib without attending to the baby's needs is not responsive caregiving.
C. Carrying the newborn every time he/she cries may not be practical or necessary, and it's important to encourage safe sleep practices.
D. Swaddling the newborn in a receiving blanket can provide comfort and a sense of security, promoting sleep and reducing crying.

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The nurse is preparing to administer a hepatitis B virus (HBV) vaccine to a newborn. Which intervention by the nurse is correct?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which documentation on a woman's chart on postpartum day 14 indicates a normal involution process?

Correct Answer is B

Explanation

A nurse in a pediatric clinic is caring for a client who is postpartum and asks the nurse what to do when her newborn cries persistently. Which of the following strategies are appropriate for the nurse to teach the new mother about her infant?

Correct Answer is D

Explanation

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