A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information?

"This is a primitive reflex known as the palmar grasp."

"This is a protective reflex known as rooting."

"This is a primitive reflex known as the plantar grasp."

"This is a protective reflex known as the Moro reflex."

Answer and Explanation

The Correct Answer is A

A. "This is a primitive reflex known as the palmar grasp.": The palmar grasp reflex is a primitive reflex observed in newborns where they automatically grasp onto objects (or fingers) that touch

their palms. This reflex typically disappears by around 6 months of age.

B. "This is a protective reflex known as rooting.": Rooting is a reflex where newborns turn their head and open their mouth in response to cheek or mouth stimulation, facilitating breastfeeding. It is not related to grasping objects with the hands.

C. "This is a primitive reflex known as the plantar grasp.": The plantar grasp reflex is similar to the palmar grasp but occurs when pressure is applied to the sole of the foot. It is unrelated to grasping objects with the hands.

D. "This is a protective reflex known as the Moro reflex.": The Moro reflex, also known as the startle reflex, involves the newborn's arms and legs extending and then flexing in response to a sudden movement or loud noise. It is not related to grasping objects with the hands.

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Correct Answer is A

Explanation

A. Appearance of pubic hair around 11 to 13 years old - Pubic hair development typically occurs around the ages of 11 to 13 in girls, signaling the onset of puberty. This is a normal part of physical development.

B. Swelling or redness of the labia minora - Swelling or redness of the labia minora may indicate inflammation or infection, unrelated to normal puberty development.

C. Lesions on the external genitalia - Lesions on the external genitalia are not normal signs of puberty and may indicate a medical issue requiring evaluation and treatment.

D. Presence of labial adhesions - Labial adhesions, where the labia minora stick together, are not directly related to puberty onset and may require medical attention if they cause discomfort or urinary issues

Correct Answer is ["90"]

Explanation

Answer: 90beats per minute

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A new mother shows the nurse that her baby grasps her finger when she touches the baby's palm. How might the nurse respond to this information?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is inspecting the genitals of a prepubescent girl. Which is a normal sign of the onset of puberty?

Correct Answer is A

Explanation

A nurse is preparing to administer digoxin to a 6-month-old infant. Prior to administering the dose, the nurse measures the apical heart rate. The nurse should withhold the dose if the infant's apical heart rate is less than what rate?

Correct Answer is ["90"]

Explanation

A nurse is assessing the fontanels of a crying newborn and notes that the posterior fontanel pulsates and briefly bulges. What do these findings indicate?

The nurse is providing teaching for the mother of an infant who receives all of his nutrition through a nasogastric feeding tube. The nurse is reviewing interventions to promote growth and development. Which response from the mother indicates a need for further teaching?

A nurse is teaching the parents of a toddler about temper tantrums. Which of the following statements should the nurse include in the teaching?

The nurse is assessing heart rate for children on the pediatric ward. What is a normal finding based on developmental age?

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The nurse is teaching a new mother about the development of sensory skills in her newborn. What would alert the mother to a sensory deficit in her child?

The nurse is describing the maturation of various organ systems during toddlerhood to the parents. What would the nurse correctly include in this description?

A nurse is teaching an assistive personnel to measure a newborn's respiratory rate. Which of the following statements indicates an understanding of why the respiratory rate should be counted for a complete minute?