Question

A nurse is caring for a newborn immediately following delivery. After assuring a patent airway, which of the following actions should be the nurse's priority?

A. Dry the newborn.
Rationale: Drying the newborn is the priority action the nurse should take. Failure to dry the newborn can result in cold stress, which poses the greatest risk to the infant's safety. Cold stress increases oxygen demand and can result in respiratory distress and hypoglycemia.
B. Administer phytonadione IM.
Rationale: The nurse should administer phytonadione to the newborn shortly after birth. However, there is another action that is the priority.
C. Document the Apgar score.
Rationale: The nurse should document the newborn's Apgar score shortly after birth. However, there is another action that is the priority.
D. Apply identification bands.
Rationale: The nurse should apply identification bands on the newborn and parents shortly after birth. However, there is another action that is the priority.

Answer 1

The nurse's priority action is to dry the newborn immediately following delivery.

Step-by-step explanation:

The nurse's priority action after assuring a patent airway for a newborn immediately following delivery would be to dry the newborn.

Failing to dry the newborn can result in cold stress which is the greatest risk to the infant's safety. Cold stress increases oxygen demand and can lead to respiratory distress and hypoglycemia.

Administering phytonadione IM, documenting the Apgar score, and applying identification bands are important actions, but they are not the priority in this situation.