The nurse receives 2 newborns within the first minutes after a vaginal delivery and intervenes to establish adequate respirations.
What is the priority issue that the nurse should address to ensure the newborn’s survival?
Hypoglycemia.
Bleeding tendencies.
Heat loss.
Fluid balance.
The Correct Answer is C
Choice A rationale
Hypoglycemia, or low blood sugar, is a concern in newborns, but it is not the most immediate concern within the first minutes after delivery.
Choice B rationale
While newborns do have certain bleeding tendencies due to immature clotting mechanisms, this is not the immediate priority in the first minutes after birth.
Choice C rationale
The priority issue that the nurse should address to ensure the newborn’s survival is heat loss.
Newborns are at high risk of heat loss and maintaining their body temperature is crucial. This is because they have a large body surface area relative to their weight and their temperature regulation mechanism is not fully developed.
Choice D rationale
Fluid balance is important in newborns, but it is not the immediate concern in the first minutes after birth. The initial focus is on establishing respiration and maintaining body temperature.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale
While assessing parenting skills is important in general, in this specific situation, the parent has expressed a fear of needles which is preventing them from being able to administer the insulin injections. Therefore, assessing parenting skills would not directly address the issue at hand.
Choice B rationale
If the child is capable and comfortable with administering their own insulin injections, this could be a viable solution to the problem. It is not uncommon for children, especially those who are older or more mature, to take over the administration of their own insulin injections. Choice C rationale
Encouraging the parent to handle the needles may be helpful, but if the parent has a strong fear of needles, this may not be a feasible solution. It’s important to respect the parent’s fear and find alternative solutions.
Choice D rationale
Asking if there is someone else who can help with the injections could potentially be a solution, but it would depend on the family’s situation and whether there is another person who is willing and able to help.
Correct Answer is C
Explanation
Choice A rationale
Placenta previa is a condition where the placenta covers the cervix, which can cause painless bleeding, not severe abdominal pain.
Choice B rationale
Oligohydramnios refers to a condition where there is less amniotic fluid around the baby in the womb. It does not typically cause severe abdominal pain.
Choice C rationale
Abruptio placenta is a serious condition where the placenta detaches from the uterus before the baby is born. It can cause severe abdominal pain and a rigid abdomen, which matches the symptoms described.
Choice D rationale
Chorioamnionitis is an infection of the membranes surrounding the fetus and the amniotic fluid. It typically presents with fever and increased heart rate, not necessarily severe abdominal pain and a rigid abdomen.
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