Which newborn assessment finding requires the nurse to take an ...

[Deast7027]

Which newborn assessment finding requires the nurse to take an action?
 
  a. Glucose level of 40 mg/dL
  b. Axillary temperature of 37 C (98.6 F)
  c. Mild yellow tinge to skin at 32 hours of age
  d. Mild inflammation of conjunctiva after eye prophylaxis

Question 2

Which should the nurse implement to prevent the kidnapping of a newborn from the hospital?
 
  a. Restricting the amount of time infants are out of the nursery
  b. Questioning anyone who is seen walking in the hallways carrying an infant
  c. Allowing no visitors in the maternity area except those who have identification bracelets
  d. Instructing the parents to not give the baby to anyone except the nurse assigned that day

[tdewitt]

Answer to Question 1

ANS: A
A glucose level of 40 mg/dL requires an action. Follow agency policy and health care provider orders regarding feeding infants with low glucose levels. A common practice is to feed the newborn if the glucose screening shows a level of 40 to 45 mg/dL or less to prevent further depletion of glucose. Infants with severe hypoglycemia may need intravenous feedings to provide glucose rapidly. A normal temperature for a newborn is 36.5 to 37.5 C (97.7 to 99.5 F). Mild jaundice at 32 hours of age is physiologic jaundice and does not need an action by the nurse, just further monitoring. Some infants develop a mild inflammation a few hours after prophylactic eye treatment.

Answer to Question 2

ANS: B
Infants should be transported in the hallways only in their cribs. Restricting the amount of time infants are out of the nursery will be difficult to monitor and will limit the mother's support system from visiting. Infants need to spend time with the parents to facilitate the bonding process. It is impossible for one nurse to be on call for one mother and baby for the entire shift, so the parents need to be able to identify the nurses who are working on the unit.