Ati Maternal Newborn

ATI MATERNAL NEWBORN A nurse is planning care for a newborn who is receiving phototherapy for an elevated bilirubin level. Which of the following actions should the nurse take? A. Offer the newborn glucose water between feedings B. Keep the newborns eye patches on during feedings. C. Apply barrier ointment to the newborn's perianal D. Use a photometer to monitor the lamp's energy. D. Use a photometer to monitor the lamp's energy Rationale: The nurse should monitor the lamp's energy throughout the therapy to ensure the newborn is receiving the appropriate amount to be effective. A nurse is assessing a client at 34 weeks gestation who has a mild placental abruption. Which of the following findings should the nurse expect? A. Dark red vaginal bleeding B. Increased platelet count C. Fetal Distress D. Decreased urinary output A. Dark red vaginal bleeding Rationale: The nurse should expect this client with mild placental abruption to have minimal dark red vaginal bleeding. 5 Sanity-Saving Tips for Arguing on the Internet A nurse is assessing a newborn and notes an axillary temperature of 96.9°F (36°C). Which of the following actions should the nurse perform? A. Obtain a rectal temperature B. Assess the newborn's blood glucose level C. Bath the newborn D. Place the infant in front of a heater vent B. Assess the newborn's blood glucose level Rationale: Infants who become cold attempt to generate heat through increased muscular and metabolic activity. This process increases glucose consumption and puts the newborn at risk of hypoglycemia. The nurse should not obtain a rectal temperature from a newborn due to the risk of rectal perforation. Bathing will increase heat loss. Infant shouldn't be bathed until temperature has stabilized within the normal range. An infant placed in front of a heater vent can incur heat loss through convection. Additionally, there is a potential fire risk from the bassinet linens and the vent. A nurse is caring for a client who is in preterm labor and is receiving magnesium sulfate. The client begins to show indications of magnesium sulfate toxicity. Which of the following medications should the nurse prepare to administer? A. Protamine sulfate B. Naloxone C. Calcium gluconate D. Flumazenil C. Calcium gluconate Rationale: The nurse should discontinue the magnesium sulfate infusion immediately and prepare to administer calcium gluconate IV to reverse the effects of magnesium sulfate and to prevent cardiac and respiratory arrest. Protamine sulfate helps reverse the effects of heparin, not magnesium sulfate. Naloxone is an opioid reversal agent. It does not reverse the effects of magnesium sulfate. Flumazenil reverses the effects of benzodiazepines such as lorazepam and alprazolam, not magnesium sulfate. A nurse is providing postpartum discharge teaching to a client who is non-lactating about breast discomfort relief measures. Which of the following pieces of information should the nurse include? A. Wear a tight-fitting bra or breast binders B. Place fresh cabbage leaves on your breasts C. Apply warmth to the breasts D. Express milk from the breasts B. Place fresh cabbage leaves on your breasts. Rationale: After 3 days postpartum, the client's breasts can become swollen and distended because of congestion of the vascular structures of the breasts. Fresh cabbage leaves can be applied to engorged breasts to help relieve breast discomfort. Breastfeeding moms can also use this nonpharmacological pain method to relieve engorgement. The coolness of the leaves and the phytoestrogens exert a therapeutic effect on engorged breasts. Replace wilted leaves. Wearing a tight-fitting bra or breast binders alleviate engorgement and swelling. Application of warmth to the breasts should be avoided because heat can stimulate milk production. An ice pack should be used to relieve engorged