ATI Maternal newborn 2. Exam questions
with answers A nurse is assessing a 4 hr old newborn who is to breastfeed and notes hands and feet that are cool and
slightly blue What action should the nurse take?
a. check the
...
ATI Maternal newborn 2. Exam questions
with answers A nurse is assessing a 4 hr old newborn who is to breastfeed and notes hands and feet that are cool and
slightly blue What action should the nurse take?
a. check the newborns temp using temporal thermometer
b. place the naked newborn on the mothers bare chest and cover both with a blanket
c. apply an o2 hood over the newborns head and neck
d. give the newborn glucose water between feedings - b. place the naked newborn on the mothers bare
chest and cover both with a blanket
Exposure to a cool environment causes vasoconstriction, which results in cool extremities with a bluish
discoloration. Placing the newborn skin-to-skin with his mother helps stabilize his temperature and
promotes bonding.
A nurse is caring for a newborn immediately following delivery. What actions should the nurse take
first?
a. place the newborn directly on the client's chest
b. administer erythromycin ophthalmic ointment
c. give the newborn vit K IM
d. perform a detailed physical assessment - a. place the newborn directly on the client's chest
The nurse should apply the safety and risk reduction priority-setting framework when caring for this
client. This framework assigns priority to the factor or situation posing the greatest safety risk to the
client. When there are several risks to client safety, the one posing the greatest threat is the highest
priority. The nurse should use Maslow's Hierarchy of Needs, the ABC priority-setting framework, or
nursing knowledge to identify which risk poses the greatest threat to the client. Therefore, the greatest
risk to the newborn is cold stress, which increases the need for oxygen and glucose. Placing the newborn
directly on the client's chest will help maintain the newborn's temperature.
A nurse is planning care for a newborn who is receiving phototherapy for an elevated bilirubin level.
What action should the nurse take?
a. apply barrier ointment to the newborn's perianal region,
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