The RN is making a client assignment for the shift, Which baby could

10 Jun The RN is making a client assignment for the shift, Which baby could

Question
The RN is making a client assignment for the shift. Which baby could be appropriately assigned to an LPN/LVN?

1

An infant being admitted for hypoglycemia.

2

A stable premature infant being fed every 2 hours.

3

An infant scheduled to receive blood this shift.

4

An infant with rising bilirubin levels.

Which newborn assessment finding would require the RN to report to the health care provider?

1

The newborn who extends the arms when hearing a loud noise.

2

The newborn whose toes flare out when the lateral heel is stroked.

3

The newborn who remains in the fetal position when lying supine.

4

The newborn whose head turns toward the cheek being stroked.

The registered nurse is caring for an infant with the nursing diagnosis of Ineffective breathing pattern and the outcome “patient will have a respiratory rate below 60 breaths per minute with no retractions”. Which is the priority nursing intervention for a baby?

1

Discourage any contact between mother and infant.

2

Place infant near exterior wall with all skin surfaces exposed.

3

Administer oxygen at 40% via oxyhood.

4

Feed patient 2 ounces every 2 hours.

The RN instructs the parents of a newborn on the actions to prevent sudden infant death syndrome. Which observation indicates that teaching has been effective?

1

Newborn is placed on the back to sleep.

2

Mother removes a pacifier from the newborn’s mouth.

3

Parents signed a waiver refusing routine immunizations after birth.

4

The baby is on an every 2-hour formula feeding schedule.

A preterm infant has received Beractant. Which assessment best indicates the client is experiencing a side effect of the medication?

1

Urinary output = 15 mL in last hour

2

Heart rate = 70

3

Respiratory rate = 35

4

Oxygen saturation = 90%

The registered nurse is caring for an infant with the nursing diagnosis of Ineffective thermoregulation. Which is a realistic, measurable patient outcome for this infant?

1

The patient’s mother will be provided with information related to thermoregulation on admission.

2

The patient will receive the correct amount of IV fluids during hospitalization.

3

The patient’s oxygen saturation will be 95% or higher on room air by discharge.

4

The patient will maintain a body temperature of 97.8° to 98.6° F by discharge.

The RN is caring for a newborn who was born at 31 weeks’ gestation. Which assessment finding should the nurse anticipate finding?

1

Limited amount of lanugo

2

The ability to suck

3

Flexion of all four extremities

4

Vernix covering the infant

Which information would the registered nurse include while teaching the new mother about umbilical cord care? Select all that apply.

1

The skin will appear moist at the cord.

2

The cord will fall off within 2 weeks.

3

Provide tub baths before the cord detaches.

4

Report any foul odor to health care provider.

5

Fold the diaper below the cord.

The RN determines further teaching is needed regarding infant car safety when which patient statement is made?

1

“We can use a rolled up receiving blanket to provide support of the baby’s head.”

2

“We disarmed one front seat air bag so we can put the car seat in the front seat.”

3

“We know to refrain from using a sack sleeper on the baby while the he is in the car seat.”

4

“We need to face the infant car seat toward the back of the car.”The RN is making a client assignment for the shift. Which baby could be appropriately assigned to an LPN/LVN?

1

An infant being admitted for hypoglycemia.

2

A stable premature infant being fed every 2 hours.

3

An infant scheduled to receive blood this shift.

4

An infant with rising bilirubin levels.

Which newborn assessment finding would require the RN to report to the health care provider?

1

The newborn who extends the arms when hearing a loud noise.

2

The newborn whose toes flare out when the lateral heel is stroked.

3

The newborn who remains in the fetal position when lying supine.

4

The newborn whose head turns toward the cheek being stroked.

The registered nurse is caring for an infant with the nursing diagnosis of Ineffective breathing pattern and the outcome “patient will have a respiratory rate below 60 breaths per minute with no retractions”. Which is the priority nursing intervention for a baby?

1

Discourage any contact between mother and infant.

2

Place infant near exterior wall with all skin surfaces exposed.

3

Administer oxygen at 40% via oxyhood.

4

Feed patient 2 ounces every 2 hours.

The RN instructs the parents of a newborn on the actions to prevent sudden infant death syndrome. Which observation indicates that teaching has been effective?

1

Newborn is placed on the back to sleep.

2

Mother removes a pacifier from the newborn’s mouth.

3

Parents signed a waiver refusing routine immunizations after birth.

4

The baby is on an every 2-hour formula feeding schedule.

A preterm infant has received Beractant. Which assessment best indicates the client is experiencing a side effect of the medication?

1

Urinary output = 15 mL in last hour

2

Heart rate = 70

3

Respiratory rate = 35

4

Oxygen saturation = 90%

The registered nurse is caring for an infant with the nursing diagnosis of Ineffective thermoregulation. Which is a realistic, measurable patient outcome for this infant?

1

The patient’s mother will be provided with information related to thermoregulation on admission.

2

The patient will receive the correct amount of IV fluids during hospitalization.

3

The patient’s oxygen saturation will be 95% or higher on room air by discharge.

4

The patient will maintain a body temperature of 97.8° to 98.6° F by discharge.

The RN is caring for a newborn who was born at 31 weeks’ gestation. Which assessment finding should the nurse anticipate finding?

1

Limited amount of lanugo

2

The ability to suck

3

Flexion of all four extremities

4

Vernix covering the infant

Which information would the registered nurse include while teaching the new mother about umbilical cord care? Select all that apply.

1

The skin will appear moist at the cord.

2

The cord will fall off within 2 weeks.

3

Provide tub baths before the cord detaches.

4

Report any foul odor to health care provider.

5

Fold the diaper below the cord.

The RN determines further teaching is needed regarding infant car safety when which patient statement is made?

1

“We can use a rolled up receiving blanket to provide support of the baby’s head.”

2

“We disarmed one front seat air bag so we can put the car seat in the front seat.”

3

“We know to refrain from using a sack sleeper on the baby while the he is in the car seat.”

4

“We need to face the infant car seat toward the back of the car.”v