The nurse receives a newborn within the first minutes after a vaginal delivery and intervenes to establish adequate respirations. What priority issue should the nurse address to ensure the newborn's survival?
Bleeding tendencies
Heat loss
Hypoglycemia
Fluid balance
The Correct Answer is B
A. Bleeding tendencies:
Bleeding tendencies are not typically a priority immediately after birth unless there is a specific indication. Newborns are not at immediate risk for bleeding unless there are underlying conditions.
B. Heat loss:
Heat loss is a significant concern for newborns. Maintaining an adequate temperature is crucial to prevent hypothermia, which can lead to complications.
C. Hypoglycemia:
While monitoring blood glucose is important in the newborn, it may not be the most immediate concern within the first minutes after delivery. Stabilizing the newborn's temperature and initiating breathing are usually higher priorities.
D. Fluid balance:
Fluid balance is essential, but the initial focus is often on establishing respirations and maintaining temperature. Fluids may be administered as needed based on the clinical assessment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Strawberries:
Strawberries contain a moderate amount of folic acid, providing a good alternative source for the client. While not as high as some vegetables, they still offer a reasonable amount of this essential nutrient. This could be a suitable option considering the client's dislike for green leafy vegetables and allergy to soy.
B. Collard greens:
Collard greens are an excellent source of folic acid. However, since the client dislikes green leafy vegetables, recommending collard greens might not align with her preferences.
C. Whole milk:
Whole milk doesn't contain significant amounts of folic acid. While it's a source of other nutrients, it isn't a primary choice for obtaining folic acid.
D. Yogurt:
Similar to whole milk, yogurt doesn't contain a substantial amount of folic acid. While it offers various health benefits due to its probiotics and nutrients, it's not a significant source of folic acid.
Correct Answer is C
Explanation
A. Hemoglobin and hematocrit:
While monitoring hemoglobin and hematocrit levels is important for assessing blood loss, in the immediate situation of a developing perineal hematoma with severe pain and pressure, assessing vital signs takes precedence to identify any signs of circulatory compromise.
B. Abdominal contour and bowel sounds:
These assessments are not the first priority in this situation. The client's complaint of severe pain and pressure in the perineum indicates a localized issue that needs immediate attention.
C. Heart rate and blood pressure:
This is the correct answer. Assessing the client's heart rate and blood pressure is crucial to identify signs of shock or compromised circulation associated with the perineal hematoma.
D. Urinary output and IV fluid intake:
While monitoring urinary output and IV fluid intake is important for overall assessment, in the context of a perineal hematoma, assessing vital signs is more immediate to identify any signs of hemodynamic instability.
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