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    ATI Maternal Newborn Proctored Exam
    Select All That Apply

    A nurse is caring for a newborn in the neonatal intensive care unit (NICU). Exhibits Select the 3 findings that require immediate follow-up.

    Explanation & Rationale

    Choice A rationale: The temperature of 36.7°C (98.1°F) is within the normal range for newborns (36.5-37.5°C). Therefore, it does not require immediate follow-up. Choice B rationale: The respiratory rate of 74/min exceeds the normal range for newborns (30-60 breaths/min), indicating potential respiratory distress. Immediate follow-up is crucial to prevent respiratory failure. Choice C rationale: The heart rate of 170/min is above the normal range for newborns (120-160 beats/min). Tachycardia can indicate stress, infection, or other underlying conditions that need prompt evaluation. Choice D rationale: Work of breathing includes signs such as retractions, nasal flaring, and grunting, which indicate respiratory distress. These signs require immediate follow-up to address any potential respiratory complications. Choice E rationale: Blood glucose level is not mentioned in the question or exhibits. Without information on blood glucose, it is not possible to determine if it requires immediate follow-up.

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