A full-term infant has just been born. Which interventions should the nurse perform first? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply
1. Placing the infant in a radiant-heated unit
2. Suctioning the infant with a bulb syringe
3. Wrapping the infant in a blanket
4. Evaluating the newborn using the Apgar system
5. Offering a feeding of 5% glucose water
1,2,4
Rationale 1: The body temperature of the newborn does not stabilize for 8–10 hours after birth.
Rationale 2: Newborns are suctioned with a bulb syringe to remove excess mucus as needed to maintain respiration.
Rationale 3: Infants should be left uncovered in a radiant warmer.
Rationale 4: The purpose of the Apgar system is to evaluate the physical condition of the newborn at birth.
Rationale 5: The nurse would first assist the mother to breastfeed if she desires. It is not necessary to give glucose water.
You might also like to view...
A client is starting hormonal therapy with tamoxifen (Nolvadex) to lower the risk for breast cancer. What information needs to be explained by the nurse regarding the action of this drug?
a. It blocks the release of luteinizing hormone. b. It interferes with cancer cell division. c. It selectively blocks estrogen in the breast. d. It inhibits DNA synthesis in rapidly dividing cells.
If the patient's white blood cell (WBC) count is 25,000/mm3 on her second postpartum day, the nurse should
a. Tell the physician immediately. b. Have the laboratory draw blood for reanalysis. c. Recognize that this is an acceptable range at this point postpartum. d. Begin antibiotic therapy immediately.
Which of the following patients would be at the highest risk for aminoglycoside-induced nephrotoxicity?
a. A 26-year-old woman with persistent headaches and tinnitus b. A 26-year-old female newlywed with chronic UTIs c. A 72-year-old patient also taking amphotericin B (Fungizone) d. A 30-year-old patient with pyelonephritis
A patient recovering from an MI asks for information about the types of meat that can be eaten. What should the nurse respond to the patient?
a. "Eat small amounts of any type of meat." b. "Eat only vegetables; you do not need to eat meat." c. "Eat lean red meat to help increase your iron levels." d. "Eat chicken and fish, keeping red meats to a minimum."