ATI RN
Nursing Interventions for Pediatric Respiratory Distress Questions
Question 1 of 5
Following a difficult vaginal birth of a singleton pregnancy, the patient starts bleeding heavily. Clots are expressed and a Foley catheter is inserted to empty the bladder because the uterine fundus is soft and displaced laterally from midline. Vital signs are 37.6°C (99.8°F), pulse 90 beats/minute, respirations 20 breaths per minute, and BP 130/90 mm Hg. Which pharmacologic intervention is indicated?
Correct Answer: C
Rationale: The correct answer is C because prostaglandin analogs can be administered intramuscularly to stop uterine bleeding in this scenario. Oxytocin may be considered, but it is not administered in a piggyback solution. Methylergonovine is contraindicated in the presence of hypertension, which the patient has. Increasing parenteral fluids will not directly address the uterine bleeding issue.
Question 2 of 5
Which method of heat loss may occur if a newborn is placed on a cold scale or touched with cold hands?
Correct Answer: B
Rationale: In understanding the nursing interventions for pediatric respiratory distress, it is crucial to comprehend the mechanisms of heat loss in newborns, as they are particularly vulnerable to temperature regulation issues. When a newborn is placed on a cold scale or touched with cold hands, heat loss occurs primarily through conduction. Conduction is the direct transfer of heat from one object to another when they come into contact. In this scenario, the cold surface of the scale or the cold hands of the caregiver directly draw heat away from the newborn's body, leading to potential heat loss and subsequent risk of hypothermia. The other options, radiation, convection, and evaporation, are not the primary mechanisms at play in this specific situation. Radiation refers to the transfer of heat through electromagnetic waves and would not be the dominant factor in direct contact with a cold surface. Convection involves the transfer of heat through air or fluid movement, which is not the case here. Evaporation pertains to the loss of heat through the conversion of a liquid to a gas, such as sweating, and is not applicable in the given context. Educationally, understanding how different modes of heat loss impact newborns is essential for nurses caring for pediatric patients, especially those at risk for respiratory distress. By recognizing the significance of conduction in situations of direct contact with cold surfaces, healthcare providers can implement targeted interventions to maintain the infant's thermal stability and overall well-being.
Question 3 of 5
The nurse is planning to conduct the initial assessment of a full-term newborn. Included in the plan is providing a neutral thermal environment. To accomplish this plan, what is the desired environmental temperature to conduct the assessment?
Correct Answer: C
Rationale: A neutral thermal environment for a full-term newborn is one in which the infant can maintain a stable body temperature with minimal oxygen need. The desired environmental temperature to conduct the assessment and provide a thermoneutral zone is 32 to 33.5°C (89.6 to 92.3°F). This range allows the infant to maintain stability without an increase in metabolic rate.
Question 4 of 5
The mother-baby nurse is providing care to a patient and her newborn 2 hours after delivery. On review of the newborn's chart, the nurse sees a notation of caput succedaneum. What will the nurse expect to find in the mother's chart?
Correct Answer: B
Rationale: Caput succedaneum is caused by pressure against the mother's cervix during labor, resulting in localized edema on the newborn's head. Therefore, the nurse would expect to find a notation of longer than usual labor in the mother's chart. This is a common occurrence related to the labor process, not related to the mother's race, use of epidural, or mode of delivery.
Question 5 of 5
The mother and infant should have identifying armbands with matching numbers. Both of these bands should be reviewed to determine that the mother has the correct infant. The other actions do not adequately verify the identities of mother and infant.
Correct Answer: C
Rationale: Having the mother read her printed band number and verifying that it matches the infant's number is the most accurate way to ensure correct identification. This procedure minimizes the risk of errors. The other options do not provide a foolproof method of verifying identities and can lead to mistakes.