A nurse is caring for four newborns in a special care nursery.
Which of the following newborn assessment findings requires immediate intervention?
Blue coloring of the hands and feet in an 8-hour-old newborn.
Small raised pearly spots on the newborn's nose.
Apical heart rate of 140 bpm.
Nasal flaring and grunting.
The Correct Answer is D
Choice A rationale
Blue coloring of the hands and feet in an 8-hour-old newborn (acrocyanosis) is a common, benign finding as the newborn’s circulatory system adjusts post-birth. It does not require immediate intervention.
Choice B rationale
Small raised pearly spots on the nose (milia) are harmless and common in newborns. They do not necessitate any intervention.
Choice C rationale
An apical heart rate of 140 bpm is within the normal range for newborns and does not require intervention.
Choice D rationale
Nasal flaring and grunting are signs of respiratory distress in a newborn. This condition demands immediate intervention to ensure the newborn’s airway is clear and breathing is adequately supported.
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Correct Answer is D
Explanation
Choice A rationale
GBS can be transmitted to the baby during both vaginal and cesarean deliveries if the mother is colonized with the bacteria. It is not limited to cesarean sections, hence why appropriate screening and treatment are essential.
Choice B rationale
GBS, although often harmless in the general population, can cause severe infections in newborns. This bacterium can be a source of severe neonatal infections like sepsis, pneumonia, and meningitis, necessitating preventive measures during pregnancy and delivery.
Choice C rationale
Screening for GBS is typically performed between 35 and 37 weeks of gestation, not at the first prenatal visit. This timing ensures accurate detection of the bacteria closer to the time of delivery.
Choice D rationale
Intravenous antibiotics during labor are recommended for mothers who test positive for GBS to prevent transmission to the baby. This intervention significantly reduces the risk of neonatal GBS infection.
Correct Answer is C
Explanation
Choice A rationale
Dexamethasone is a corticosteroid and is not used for treating ectopic pregnancy.
Choice B rationale
Clomid (clomiphene citrate) is used to stimulate ovulation, not to treat ectopic pregnancy.
Choice C rationale
Methotrexate is a chemotherapeutic agent that effectively stops the growth of ectopic pregnancy cells, allowing the pregnancy tissue to be reabsorbed by the body.
Choice D rationale
Progesterone supports pregnancy and is not used to treat ectopic pregnancy.