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RN Nursing · Newborn Complications — Respiratory Distress · Practice question

A nurse is assessing a newborn 15 minutes after birth and observes a respiratory rate of 70 breaths per minute accompanied by nasal flaring and intercostal retractions. The newborn’s skin shows cyanosis around the mouth. What is the nurse’s priority action?

Answer & explanation

Correct: Notify the healthcare provider immediately and prepare for potential respiratory support.

A respiratory rate of 70 breaths per minute, nasal flaring, intercostal retractions, and perioral cyanosis in a newborn 15 minutes after birth indicate respiratory distress that exceeds normal transitional findings. While some mild tachypnea and acrocyanosis can be seen in the first few minutes after birth, persistent perioral cyanosis combined with signs of increased work of breathing — nasal flaring and intercostal retractions — are abnormal and require immediate provider notification and preparation for respiratory support such as supplemental oxygen, CPAP, or bag-mask ventilation. These findings may indicate conditions such as transient tachypnea of the newborn, respiratory distress syndrome, meconium aspiration syndrome, or a cardiac anomaly. Administering prophylactic antibiotics is not the priority because respiratory support takes precedence over infection prevention in this acute scenario. Breastfeeding is contraindicated when a newborn is in respiratory distress, as the infant cannot safely coordinate sucking, swallowing, and breathing. Continuing to monitor without intervention is inappropriate given the severity and combination of signs — waiting could lead to rapid deterioration. The priority is always to secure the airway and ensure adequate oxygenation, making immediate provider notification and preparation for respiratory support the correct and safest response.

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