Which of the following symptoms should the nurse recognize as a manifestation of neonatal abstinence syndrome?

Decreased muscle tone

Exaggerated Moro reflex

Consoles easily

Weak cry

Answer and Explanation

The Correct Answer is B

A.   Decreased muscle tone is not typically associated with neonatal abstinence syndrome.
B.   Exaggerated Moro reflex, which is a startle response that causes the baby to fling their arms and legs out and then curl them in, is a common signof neonatal abstinence
C.   Consoling easily is not a characteristic feature of neonatal abstinence syndrome; these infants are often difficult to console.
D.   A high pitched cry is a common symptom of neonatal abstinence syndrome. A weak cry is not anticipated.

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Correct Answer is A

Explanation

A. The newborn with blue hands and feet (acrocyanosis) along with a normal axillary temperature of 36.6°C (97.9°F) could indicate a need for further assessment. While acrocyanosis can be normal in newborns, it is essential to monitor for any signs of respiratory distress or circulatory issues. Since this newborn is exhibiting a potential sign of compromised circulation, this infant should be attended to first.

B. A newborn who has lost 12% of her birth weight is concerning, as significant weight loss in newborns can indicate feeding problems or other underlying issues. However, this would not take precedence over potential acute issues like those indicated in option A.

C. A newborn who is 24 hours post-circumcision with yellow exudate is expected to have some discharge as part of the healing process. If the exudate is not foul-smelling and there are no signs of infection, this is typically a normal finding.

D. A newborn with a blood glucose level of 63 mg/dL is within the normal range for newborns, as acceptable levels are typically above 40 mg/dL. Therefore, this does not require immediate attention.

A. An Rh-negative client who has an Rh-negative newborn B. An Rh-negative client who has an Rh-positive newborn C. An Rh-positive client who has an Rh-positive newborn D. An Rh-positive client who has an Rh-negative newborn

Correct Answer is B

Explanation

A. If both the mother and the newborn are Rh-negative, there is no need for Rh (D. immune globulin.
B. An Rh-negative mother carrying an Rh-positive baby is at risk for Rh incompatibility. She should receive Rh (D. immune globulin to prevent sensitization.
C. If both the mother and the newborn are Rh-positive, there is no need for Rh (D. immune globulin.
D. If the mother is Rh-positive and the newborn is Rh-negative, there is no need for Rh (D. immune globulin.

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Which of the following symptoms should the nurse recognize as a manifestation of neonatal abstinence syndrome?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is receiving change-of-shift report for four newborns. Which of the following newborns should the nurse attend to first?

Correct Answer is A

Explanation

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Correct Answer is B

Explanation

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