# Situation: A nurse in a level II nursery of a provincial hospital cares for newborns with risk factors identified at birth. A term newborn is 10 hours old. His mother's membranes ruptured 20 hours before birth, her group B streptococcus status is unknown, and she had a fever of 38.4 °C in labor. The newborn now has a temperature of 36.2 °C, poor feeding, and grunting; he is under a radiant warmer receiving oxygen, with an oxygen saturation of 96%. A blood culture, ampicillin, and gentamicin are ordered. What should the nurse do FIRST?

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=629642  
> language: ko  
> subject: Nursing Practice II — Maternal and Child Health Nursing

## 문제

Situation: A nurse in a level II nursery of a provincial hospital cares for newborns with risk factors identified at birth.

A term newborn is 10 hours old. His mother's membranes ruptured 20 hours before birth, her group B streptococcus status is unknown, and she had a fever of 38.4 °C in labor. The newborn now has a temperature of 36.2 °C, poor feeding, and grunting; he is under a radiant warmer receiving oxygen, with an oxygen saturation of 96%. A blood culture, ampicillin, and gentamicin are ordered. What should the nurse do FIRST?

## 보기

1. Give the ampicillin first, then draw the blood culture
2. Draw the blood culture, then give both antibiotics **✔ 정답**
3. Give the ampicillin and gentamicin together in one line
4. Wait for the blood count and C-reactive protein results

**정답: 2**

## 해설

Prolonged rupture of membranes (18 hours or more), intrapartum fever, and unknown group B streptococcus status, with hypothermia, poor feeding, and grunting, point to early-onset sepsis. With oxygenation supported, the blood culture is drawn before the first dose so the organism can be identified, and empiric ampicillin plus gentamicin are then given without delay.

## 심화 해설

Why this newborn is high risk

This infant has several classic red flags for early-onset sepsis (EOS). Membrane rupture lasting 20 hours exceeds the 18-hour threshold that increases ascending bacterial exposure. Maternal intrapartum fever of 38.4 °C and unknown group B streptococcus status add further concern. The newborn’s 36.2 °C temperature, poor feeding, and grunting are clinical signs consistent with sepsis rather than normal transition. Together, these maternal and neonatal findings justify immediate sepsis evaluation and empiric antibiotic therapy.

Why the blood culture comes first

The priority is to obtain the blood culture before the first antibiotic dose is infused. Antibiotics given first can suppress bacterial growth in the culture bottle and produce a false-negative result, which would leave the organism unidentified and make targeted therapy impossible. Drawing the culture first preserves the best chance of recovering the causative organism and guiding later antibiotic decisions. This principle is central to antimicrobial stewardship: treat promptly, but do not destroy the diagnostic evidence before it is collected.

Why antibiotics should not be delayed

Once the culture is drawn, both ampicillin and gentamicin are given without waiting for the blood count or C-reactive protein. In a symptomatic newborn with this risk profile, delaying antibiotics while awaiting inflammatory markers is unsafe. Ampicillin provides coverage for group B streptococcus and Listeria, while gentamicin adds gram-negative coverage, including Escherichia coli. Empiric dual therapy is started immediately because early-onset sepsis can progress rapidly in the first hours of life.

Why the other options are incorrect

Giving ampicillin before the blood culture risks a false-negative culture. Administering ampicillin and gentamicin together in one line is unsafe because incompatibility and precipitation can occur; they require separate IV access or sequential administration with flushing. Waiting for blood count and C-reactive protein results delays needed treatment in a newborn who already shows clinical deterioration.

| Action | Correct sequence | Rationale |
| --- | --- | --- |
| Blood culture | First | Obtain before antibiotics to identify the organism |
| Ampicillin | Second | Empiric gram-positive and Listeria coverage |
| Gentamicin | Second, separate line | Empiric gram-negative coverage; avoid mixing with ampicillin |
| Blood count and CRP | After antibiotics are started | Supportive data, not a reason to delay treatment |

Nursing priority in this scenario

The nurse should first draw the blood culture, then administer both antibiotics promptly. Key point! The culture must precede the first antibiotic dose, but antibiotic administration should not be postponed for laboratory results. Watch out! A normal oxygen saturation of 96% under a radiant warmer does not rule out sepsis; hypothermia, poor feeding, and grunting are more specific warning signs in this context.

## 임상 시나리오

Blood Culture Before Antibiotics in Suspected Neonatal SepsisPreserve the diagnostic evidence, then treat without delay
In a symptomatic newborn with risk factors for early-onset sepsis, obtain the blood culture before the first antibiotic dose. Antibiotics given first can suppress bacterial growth and cause a false-negative culture, leaving the organism unidentified.

Once the culture is drawn, give ampicillin and gentamicin immediately. Do not wait for complete blood count or C-reactive protein results in a symptomatic high-risk newborn.

Risk factors include membrane rupture 18 hours or more, maternal intrapartum fever 38.4 °C, and unknown group B streptococcus status. Clinical signs such as hypothermia, poor feeding, and grunting support the diagnosis.

CautionAmpicillin and gentamicin are incompatible and must not be mixed in the same line; administer them separately.

## 핵심 개념

- **Early-onset sepsis (EOS)** — Sepsis occurring within the first 72 hours of life, commonly caused by group B streptococcus or Escherichia coli acquired during delivery.
- **Prolonged rupture of membranes** — Membrane rupture lasting 18 hours or more, which increases the risk of ascending bacterial infection in the fetus.
- **Empiric antibiotic therapy** — Broad-spectrum antibiotics started before the causative organism is identified, based on likely pathogens.
- **Antimicrobial stewardship** — Practice of obtaining cultures before antibiotics to preserve diagnostic evidence and guide targeted therapy.
- **Group B streptococcus (GBS)** — A common cause of neonatal sepsis; ampicillin is the first-line empiric agent for coverage.

## 같은 주제 문제

- [Situation: A nurse works in the neonatal intensive care unit (NICU) of a tertiary hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=629441)
- [Situation: A nurse works in the neonatal intensive care unit (NICU) of a tertiary hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=629442)
- [Situation: A nurse works in the neonatal intensive care unit (NICU) of a tertiary hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=629443)
- [Situation: A nurse works in the neonatal intensive care unit (NICU) of a tertiary hospital…](https://mymerci.kr/pages/nclex_q.php?qn_id=629444)
- [Situation: A nurse on the pediatric cardiology and surgical ward cares for infants with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=629445)
- [Situation: A nurse on the pediatric cardiology and surgical ward cares for infants with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=629446)
- [Situation: A nurse on the pediatric cardiology and surgical ward cares for infants with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=629447)
- [Situation: A nurse on the pediatric cardiology and surgical ward cares for infants with co…](https://mymerci.kr/pages/nclex_q.php?qn_id=629448)

---

More free questions: [기출문제](https://mymerci.kr/)

_학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._