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
Transient circumoral cyanosis
Single palmar creases
Subconjunctival hemorrhage
The Correct Answer is C
A. Rust-stained urine: This is a common finding in newborns and is due to urate crystals in the urine. It is benign and typically resolves as the infant's kidney function matures.
B. Transient circumoral cyanosis: This is a common finding in newborns, particularly during crying or feeding, and it usually resolves on its own. It does not typically indicate a serious condition.
C. A single palmar crease (also known as a simian crease) can be a normal variant, but it is often associated with certain congenital anomalies or chromosomal disorders, such as Down syndrome. The nurse should report this finding to the provider for further evaluation and possible genetic testing.
D. Subconjunctival hemorrhage: This can occur during delivery due to the pressure of vaginal birth. It is harmless and usually resolves within a few weeks without treatment.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
The correct answer is choice C, the newborn's pulse oximetry is 91%. A pulse oximetry reading below 95% indicates hypoxemia, which can occur when the newborn has excessive secretions or a partial airway obstruction. Suctioning the nasopharynx can help to remove the secretions or obstruction and improve the newborn's oxygen saturation. Assessment of the newborn's respiratory rate and pattern, as well as coughing, are important in determining if the newborn needs suctioning. However, the presence of these signs alone does not indicate that suctioning is required. Additionally, a respiratory rate of 32/min is within the normal range for a newborn, so it does not indicate a need for suctioning.
Correct Answer is D
Explanation
The nurse should explain to the client that amniocentesis is a diagnostic test that is performed between 15 and 20 weeks of gestation to determine if the fetus has genetic or congenital disorders. While the procedure can also determine the sex of the fetus, this is not typically the primary reason for the test. The nurse should clarify any misconceptions the client has about the procedure and provide education on its purpose, risks, and benefits. The nurse should also assess the client's understanding of the information provided and address any questions or concerns the client may have.
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