A nurse is assessing a newborn the day after delivery. The nurse notes a raised, bruised area on the left side of the scalp that does not cross the suture line. How should the nurse document this finding?
Molding
Caput succedaneum
Pilonidal dimple
Cephalhematoma
The Correct Answer is D
A. Molding refers to the shaping of the fetal head during labor and delivery to facilitate passage through the birth canal. It typically resolves within a few days and does not involve bruising.
B. Caput succedaneum is localized swelling or edema of the scalp that crosses suture lines and typically resolves within a few days. It is not associated with bruising.
C. Pilonidal dimple refers to a small pit or depression in the skin, typically at the base of the spine, and is not related to the finding described.
D. Cephalhematoma is a collection of blood between the skull bone and its periosteum. It is
confined by suture lines and may take weeks to resolve. It does not cross suture lines and may be associated with bruising due to birth trauma.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. Breast milk typically "comes in" or becomes more abundant between 3 to 5 days after birth as colostrum transitions to mature milk.
B. Within 2 days is too soon for most women to experience their milk "coming in."
C. 6 to 8 days is later than the typical timeframe for milk production to increase significantly.
D. About 10 days is longer than the average time for breast milk to "come in" for most postpartum women.
Correct Answer is C
Explanation
A. Absent plantar reflexes may indicate neurological issues but are not specifically associated with developmental dysplasia of the hip (DDH).
B. Lengthened thigh on the affected side is not a typical finding in DDH. Instead, there may be apparent shortening due to hip dislocation.
C. Asymmetric thigh folds are a common finding in DDH due to hip instability, causing the femoral head to be displaced from the acetabulum and resulting in uneven thigh folds.
D. An inwardly turned foot on the affected side may be seen in conditions like clubfoot but is not a characteristic finding in DDH.
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