Nursing practice questions with comprehensive rationales
NurseDive Free Nursing Practice Question
A nurse is caring for a newborn who has early-onset VKDB due to maternal use of anticoagulants during pregnancy.
Which of the following interventions should the nurse anticipate for this newborn?
A. Administer fresh frozen plasma
Fresh frozen plasma contains clotting factors that can help stop the bleeding caused by vitamin K deficiency.Vitamin K is needed for the synthesis of clotting factors in the liver, but newborns have low levels of vitamin K and may develop vitamin K deficiency bleeding (VKDB) if they do not receive prophylaxis at birth.VKDB can manifest as bleeding in various sites, such as the skin, mucous membranes, umbilicus, gastrointestinal tract, or central nervous system.
B. Administer packed red blood cells
Packed red blood cells do not contain clotting factors and will not correct the underlying deficiency of vitamin K.
C. Administer intravenous immunoglobulin
Intravenous immunoglobulin is used to treat immune-mediated thrombocytopenia, not vitamin K deficiency.
D. Administer recombinant erythropoietin
Recombinant erythropoietin is used to stimulate red blood cell production in anemia, not to treat bleeding disorders
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Full Explanation
The correct answer is choice A. Administer fresh frozen plasma. This is because fresh frozen plasma contains clotting factors that can help stop the bleeding caused by vitamin K deficiency. Vitamin K is needed for the synthesis of clotting factors in the liver, but newborns have low levels of vitamin K and may develop vitamin K deficiency bleeding (VKDB) if they do not receive prophylaxis at birth. VKDB can manifest as bleeding in various sites, such as the skin, mucous membranes, umbilicus, gastrointestinal tract, or central nervous system.
Choice B is wrong because packed red blood cells do not contain clotting factors and will not correct the underlying deficiency of vitamin K.
Choice C is wrong because intravenous immunoglobulin is used to treat immune-mediated thrombocytopenia, not vitamin K deficiency.
Choice D is wrong because recombinant erythropoietin is used to stimulate red blood cell production in anemia, not to treat bleeding disorders.
Early-onset VKDB occurs within 24 hours of birth and is associated with maternal use of drugs that interfere with vitamin K metabolism, such as anticoagulants, anticonvulsants, or antituberculosis drugs .
These drugs induce the enzymes that break down vitamin K in the fetal liver
Similar Questions
A nurse is assessing a newborn who has late-onset VKDB due to exclusive breastfeeding and inadequate oral vitamin K supplementation.
Which of the following findings should indicate a possible intracranial hemorrhage to the nurse?
A. Bulging fontanelle
A bulging fontanelle is a sign of increased intracranial pressure, which can be caused by intracranial hemorrhage. Late-onset VKDB is a condition that occurs in infants who have low levels of vitamin K, which is essential for blood clotting.Most cases of late-onset VKDB present with intracranial hemorrhage.
B. Sunken eyes
Sunken eyes is wrong because it is a sign of dehydration, not intracranial hemorrhage.
C. Mottled skin
Mottled skin is wrong because it is a sign of poor circulation or shock, not intracranial hemorrhage.
D. Flaring nostrils
Flaring nostrils is wrong because it is a sign of respiratory distress, not intracranial hemorrhage.
Full Explanation
The correct answer is choice A. Bulging fontanelle.
A bulging fontanelle is a sign of increased intracranial pressure, which can be caused by intracranial hemorrhage.
Late-onset VKDB is a condition that occurs in infants who have low levels of vitamin K, which is essential for blood clotting. Most cases of late-onset VKDB present with intracranial hemorrhage.
Choice B. Sunken eyes is wrong because it is a sign of dehydration, not intracranial hemorrhage.
Choice C. Mottled skin is wrong because it is a sign of poor circulation or shock, not intracranial hemorrhage.
Choice D. Flaring nostrils is wrong because it is a sign of respiratory distress, not intracranial hemorrhage.
Normal ranges for vitamin K plasma concentrations are 0.2 to 3.2 ng/mL for adults and 0.15 to 1.5 ng/mL for infants.
A nurse is assessing a newborn who has hypoglycemia due to perinatal asphyxia.
Which of the following findings should the nurse expect? (Select all that apply.)
A. Irregular respirations
Irregular respirations can result from hypoglycemia due to perinatal asphyxia. Hypoglycemia can impair the respiratory center in the brainstem and cause irregular breathing patterns.
B. Cyanosis
N/A
C. Apnea
Apnea can result from hypoglycemia due to perinatal asphyxia. Apnea is defined as a pause in breathing
D. Eye-rolling
Hypoglycemia due to perinatal asphyxia can cause various neurological signs in the newborn, such as irregular respirations, apnea, eye-rolling, and lethargy. These signs indicate inadequate oxygenation and glucose delivery to the brain. Cyanosis is not a specific sign of hypoglycemia, but rather a sign of poor oxygenation that can occur due to other causes.
E. Lethargy
N/A
Full Explanation
The correct answer is choice A, C, D, and E. Hypoglycemia due to perinatal asphyxia can cause various neurological signs in the newborn, such as irregular respirations, apnea, eye-rolling, and lethargy.
These signs indicate inadequate oxygenation and glucose delivery to the brain. Cyanosis is not a specific sign of hypoglycemia, but rather a sign of poor oxygenation that can occur due to other causes.
Therefore, choice B is wrong.
Choice A is correct because irregular respirations can result from hypoglycemia due to perinatal asphyxia. Hypoglycemia can impair the respiratory center in the brainstem and cause irregular breathing patterns.
Choice C is correct because apnea can result from hypoglycemia due to perinatal asphyxia.
Apnea is defined as a pause in breathing
A nurse is caring for a preterm newborn who has hypoglycemia due to inadequate gluconeogenesis.
The nurse should understand that this condition occurs because preterm newborns have limited stores of which of the following substances?
A. Glycogen
Preterm newborns have limited stores of glycogen, which is a substance made from glucose that is stored in the liver and muscle cells to be used later for energy.When blood glucose levels are low, the hormone glucagon signals the cells to convert glycogen back into glucose and release it into the bloodstream.However, preterm newborns have a reduced ability to produce glucagon and to use gluconeogenesis, which is the process of making new glucose from other sources.Therefore, they are at risk of hypoglycemia, which is a condition where blood glucose levels are too low to support normal brain function.
B. Glucose
Glucose is the sugar that travels through the blood to fuel the cells, not a substance that is stored for later use.
C. Insulin
Insulin is a hormone that helps cells absorb glucose from the blood, not a substance that is stored for later use.
D. Glucagon
Glucagon is a hormone that triggers the release of glucose from the liver and muscle cells, not a substance that is stored for later use.
Full Explanation
The correct answer is choice A. Glycogen. Preterm newborns have limited stores of glycogen, which is a substance made from glucose that is stored in the liver and muscle cells to be used later for energy. When blood glucose levels are low, the hormone glucagon signals the cells to convert glycogen back into glucose and release it into the bloodstream. However, preterm newborns have a reduced ability to produce glucagon and to use gluconeogenesis, which is the process of making new glucose from other sources. Therefore, they are at risk of hypoglycemia, which is a condition where blood glucose levels are too low to support normal brain function.
Choice B is wrong because glucose is the sugar that travels through the blood to fuel the cells, not a substance that is stored for later use.
Choice C is wrong because insulin is a hormone that helps cells absorb glucose from the blood, not a substance that is stored for later use.
Choice D is wrong because glucagon is a hormone that triggers the release of glucose from the liver and muscle cells, not a substance that is stored for later use.