A nurse is caring for a client who is postpartum. The client tells the nurse that the newborn's maternal grandmother was born deaf and asks how to tell if her newborn hears well.
Which of the following statements should the nurse make?
"The best way to determine if your baby can hear is to clap your hands loudly and see if she startles.”.
"Look at how she looks at you when you speak.
That's a good sign.”.
"We do routine hearing screenings on newborns.
You'll know before you leave the hospital if additional evaluation is recommended.”.
The Correct Answer is C
Choice A rationale
Clapping hands to assess hearing is not a reliable method and could startle the baby for reasons unrelated to hearing ability.
Choice B rationale
While a newborn might respond to visual stimuli, this is not a definitive method to assess hearing.
Choice C rationale
Routine hearing screenings using objective tests are the best way to determine a newborn's hearing ability, providing accurate and early detection of potential hearing issues.
Choice D rationale
This statement is misleading, as some forms of hearing loss can be inherited. It's important to use accurate methods to assess newborn hearing.
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Correct Answer is ["A","B","C"]
Explanation
Choice A: Give betamethasone 12 mg IM now and repeat in 24 hr.
Rationale: Betamethasone is administered to accelerate fetal lung maturity in cases of preterm labor. Given the client's gestational age of 31 weeks, this intervention is appropriate to help reduce the risk of respiratory distress syndrome in the newborn.
Choice B: Begin loading dose of magnesium sulfate 9 g over 30 min.
Rationale: Magnesium sulfate is used for neuroprotection of the fetus in preterm labor to reduce the risk of cerebral palsy. The loading dose is typically given to achieve therapeutic levels quickly.
Choice C: Position the client in a lateral position.
Rationale: Positioning the client in a lateral position helps improve uteroplacental blood flow and can reduce the intensity of contractions, which is beneficial in managing preterm labor.
Correct Answer is ["A","B","C","D","E","F"]
Explanation
B. Remove the newborn from phototherapy every 4 hours for thorough assessment of adverse effects of phototherapy.
D. Maintain an eye mask over the newborn's eyes.
E. Reposition the newborn every 2 hours.
F. Report sunken fontanels to the provider. Contraindicated:
A. Apply lotion to the skin every 4 hours.
C. Newborn feedings should be every 8 hours.