RN Nursing · Newborn Assessment · Practice question
A nurse is caring for a newborn immediately following delivery. After ensuring the airway is patent, the newborn exhibits mild respiratory distress with intermittent apnea. What is the nurse's priority intervention to stabilize the newborn's respiratory status?
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Administer intravenous fluids to maintain hydration and prevent hypoglycemia.
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Place the newborn in a Fowler's position with the head of the bed elevated to 45 degrees to reduce aspiration risk.
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✓
Provide tactile stimulation by gently rubbing the soles of the newborn's feet to stimulate spontaneous breathing.
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Prepare the newborn for immediate intubation and mechanical ventilation.
Answer & explanation
Correct: Provide tactile stimulation by gently rubbing the soles of the newborn's feet to stimulate spontaneous breathing.
In a newborn exhibiting mild respiratory distress with intermittent apnea, the least invasive and most appropriate first intervention is tactile stimulation, such as gently rubbing the soles of the feet. Neonatal apnea, particularly in newborns in the immediate post-delivery period, is often responsive to simple tactile stimulation, which activates peripheral sensory receptors and prompts the resumption of spontaneous breathing. This is an established component of neonatal resuscitation guidelines and is consistent with the least-invasive approach before escalating to more aggressive interventions. Immediate intubation and mechanical ventilation are indicated only when the infant fails to respond to stimulation and positive-pressure ventilation, making that option premature. Elevating the head of the bed to 45 degrees in a Fowler's position is not the standard positioning recommendation for newborns in respiratory distress; a neutral position with slight neck extension is preferred to open the airway. Administering intravenous fluids addresses hydration and glucose concerns but does not directly treat or stabilize respiratory status. Following initial tactile stimulation, if the infant remains apneic or bradycardic, escalation of care according to the Neonatal Resuscitation Program algorithm is appropriate.
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