Observe the range of motion of the shoulders and arms.This is because a brachial plexus injury affects the nerve network that provides feeling and muscle control in the shoulder, arm, forearm, hand, and fingers.A baby with a brachial plexus injury may have full or partial lack of movement, a weakened grip, numbness, or an odd position of the affected arm.

Observing the range of motion of the shoulders and arms can help detect any signs of nerve damage or weakness.

Choice A is wrong because palpating the clavicles for crepitus or deformity is a way to check for a possible clavicular fracture, not a brachial plexus injury.

Choice C is wrong because measuring the head circumference and comparing it with the chest circumference is a way to check for a possible cephalopelvic disproportion (CPD), not a brachial plexus injury.

Choice D is wrong because auscultating the lungs for crackles or wheezes is a way to check for a possible respiratory distress, not a brachial plexus injury.

“I should expect to have a cesarean section because vaginal delivery is too risky.” This statement indicates a need for further teaching because it is not true that all women with diabetes mellitus and macrosomia need to have a cesarean section.

The mode of delivery depends on several factors, such as the estimated fetal weight, the maternal pelvic size, the fetal position, and the presence of any complications.

The nurse should explain to the client that vaginal delivery may be possible if the conditions are favorable and the risks are low.

Choice A is wrong because it is a correct statement.

Women with diabetes mellitus should monitor their blood glucose levels closely and follow their prescribed diet to prevent hyperglycemia and fetal macrosomia.

Choice B is wrong because it is also a correct statement.

Women with diabetes mellitus and macrosomia should have regular prenatal visits and ultrasounds to monitor their baby’s growth and well-being.

Choice D is wrong because it is another correct statement.

Women with diabetes mellitus and macrosomia should be aware of the signs of hypoglycemia in their baby after birth, such as jitteriness, lethargy, poor feeding, and low temperature.

The baby may need glucose supplementation or intravenous fluids to maintain normal blood glucose levels.

Normal ranges:

• Blood glucose levels: 70-110 mg/dL (3.9-6.1 mmol/L) for fasting; <140 mg/dL (<7.8 mmol/L) for postprandial

• Estimated fetal weight: 2500-4000 g (5.5-8.8 lb) for term

A hematocrit of 75% indicates polycythemia, which is a condition of having too many red blood cells.Polycythemia is a common complication of macrosomia, which is a condition of having a birth weight of more than 8 pounds, 13 ounces.Polycythemia can cause problems such as jaundice, seizures, and organ dysfunction.

Choice B is wrong because a hemoglobin of 12 g/dL is within the normal range for a newborn, which is 14 to 24 g/dL.

Choice C is wrong because a platelet count of 150,000/mm3 is within the normal range for a newborn, which is 150,000 to 450,000/mm3.

Choice D is wrong because a white blood cell count of 9,000/mm3 is within the normal range for a newborn, which is 9,000 to 30,000/mm3.

Cover the newborn’s eyes with eye shields or patches.This is because phototherapy exposes the newborn to high-intensity light that can damage the retina and cause eye irritation.Eye shields or patches should be removed every 4 hours to check for eye infection, injury, or displacement.

Choice B is wrong because sunscreen lotion can block the effect of phototherapy and increase the risk of skin irritation and infection.The newborn’s skin should be exposed as much as possible to the light source.

Choice C is wrong because feeding the newborn every 4 hours is not enough to prevent dehydration.Phototherapy can increase insensible water loss and fluid requirements.The newborn should be fed every 2 to 3 hours or on demand, and the urine output and weight should be monitored closely.

Choice D is wrong because turning off the phototherapy lights during blood draws can reduce the efficacy of the treatment and prolong the duration of exposure.The lights should be turned off only when absolutely necessary, such as during physical examination or parental bonding.

Feed the newborn formula or breastmilk as prescribed.This is because newborns with macrosomia (large birth weight) are at risk of hypoglycemia (low blood sugar) due to increased insulin production in response to high glucose levels in the womb.Formula or breastmilk provide adequate glucose and nutrients to prevent or treat hypoglycemia.

Choice B is wrong because glucose water does not provide enough calories or protein for growth and development.

Choice C is wrong because honey or corn syrup can cause infant botulism, a serious infection that affects the nervous system.

Choice D is wrong because rice cereal or oatmeal are not appropriate for newborns, as they can cause choking, allergies, or overfeeding.

Normal ranges for blood glucose levels in newborns are 40 to 150 mg/dL (2.2 to 8.3 mmol/L).Newborns with a suspected or confirmed genetic hypoglycemia disorder have a lower threshold of 70 mg/dL (3.9 mmol/L).