A nurse is assessing a full-term newborn upon admission to the nursery. Which of the following clinical findings should the nurse report to the provider?
Rust-stained urine.
Single palmar creases.
Subconjunctival hemorrhage.
Transient circumoral cyanosis
The Correct Answer is B
The correct answer is choice B. Single palmar creases.
Choice A rationale:
Rust-stained urine is typically due to urate crystals and is common in newborns. It usually resolves on its own and is not a cause for concern.
Choice B rationale:
Single palmar creases can be associated with certain genetic conditions, such as Down syndrome. This finding should be reported to the provider for further evaluation.
Choice C rationale:
Subconjunctival hemorrhage is a common finding in newborns due to the pressure changes during delivery. It usually resolves without intervention and is not typically a cause for concern.
Choice D rationale:
Transient circumoral cyanosis is often seen in newborns and can occur when the baby is crying or feeding. It usually resolves on its own and is not typically a cause for concern.
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Related Questions
Correct Answer is ["A","D","E"]
Explanation
These are the findings that place the client at risk for postpartum hemorrhage. Postpartum hemorrhage (PPH) is severe vaginal bleeding after childbirth. It can be a life-threatening condition that requires prompt treatment. The most common cause of PPH is uterine atony, which is when the uterus does not contract enough to stop the bleeding from the placental site¹. Factors that can increase the risk of uterine atony include:
- History of uterine atony: Having a previous episode of PPH due to uterine atony makes it more likely to
happen again in subsequent deliveries.
- Labor induction with oxytocin: Oxytocin is a hormone that stimulates uterine contractions. However, prolonged or excessive use of oxytocin during labor can cause uterine fatigue and reduce its ability to contract after delivery.
- Vacuum-assisted delivery: A vacuum extractor is a device that helps deliver the baby by applying suction to the baby's head. This can cause trauma to the uterus and increase the risk of bleeding.
The other options are not correct because they are not risk factors for postpartum hemorrhage. Let me
explain why:
b) History of human papillomavirus
Human papillomavirus (HPV) is a common sexually transmited infection that can cause genital warts and cervical cancer. However, it does not increase the risk of postpartum hemorrhage. HPV may affect the cervix, but not the uterus or the placenta, which are the main sources of bleeding after delivery³.
c) Newborn weight 2.948 kg (6 Ib 8 oz)
This is a normal newborn weight and does not increase the risk of postpartum hemorrhage. A large baby (more than 4 kg or 8.8 Ib) may increase the risk of uterine atony by overdistending the uterus, but this is not the case for this newborn².
Correct Answer is A
Explanation
Hemolytic disease of the newborn (HDN) is a condition that occurs when there is an incompatibility between the blood types of the mother and the baby. It causes the mother's immune system to produce antibodies that attack and destroy the baby's red blood cells, leading to anemia, jaundice, organ enlargement, and other complications¹.
One of the most common causes of HDN is Rh incompatibility. This happens when the mother is Rh negative and the baby is Rh positive. The Rh factor is a protein that can be present or absent on the surface of red blood cells. People who have the protein are Rh positive and people who do not have it are Rh negative
Rh incompatibility can cause HDN when the baby's Rh positive blood cells cross the placenta and enter the mother's bloodstream. This can happen during delivery, miscarriage, abortion, or invasive prenatal testing. The mother's immune system recognizes the baby's blood cells as foreign and produces antibodies against them. These antibodies can cross back to the baby's bloodstream and attack the baby's red blood cells, causing hemolysis (breakdown) and anemia².
HDN due to Rh incompatibility usually does not affect the first pregnancy, because the mother has not been exposed to Rh positive blood before and has not developed antibodies yet. However, it can affect subsequent pregnancies with Rh positive babies, because the mother has become sensitized and has antibodies ready to attack².
The other options are not causes of HDN:
- a) The mother and the father are both Rh negative. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh negative and will not trigger an immune response from the mother².
- b) The mother and the father are both Rh positive. This is not a cause of HDN because both parents have the same Rh factor and there is no incompatibility between them. The baby will also be Rh positive and will not trigger an immune response from the mother².
- c) The mother is Rh positive and the father is Rh negative. This is not a cause of HDN because the mother has a dominant Rh factor and will not produce antibodies against it. The baby will either be Rh positive or Rh negative, depending on whether they inherit the father's gene or not. In either case, the baby's blood type will not trigger an immune response from the mother².
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