A nurse is assisting with the care of a newborn 1 hr after birth.

Select the 5 findings that the nurse should report to the provider.

Choice A reason:

This statement is not appropriate because it does not provide any information or education to the client who wants to know about VBAC. It also implies that the nurse does not have any knowledge or expertise on the topic, which may undermine the client's trust and confidence in the nurse.

Choice B reason:

This statement is not appropriate because it is not evidence-based and may discourage the client from considering VBAC as a possible option. According to research, VBAC is associated with fewer complications than an elective repeat C-section for many women who had prior

cesarean deliveries. A repeat C-section also carries risks such as infection, bleeding, injury to organs, and placental problems in future pregnancies.

Choice C reason:

This statement is appropriate because it is accurate and informative. The type of uterine incision used for the prior C-section is one of the most important factors that determine the eligibility and success of VBAC. A low transverse or low vertical incision is usually compatible with VBAC, while a high vertical (classical) incision is not recommended due to the risk of uterine rupture.

Choice D reason:

This statement is not appropriate because it dismisses the client's concern and does not address their question. It also implies that the nurse does not respect the client's autonomy and right to make informed decisions about their care. The client may benefit from learning about VBAC early in their pregnancy so that they can weigh the pros and cons and discuss their preferences with their provider.

Choice A reason:

Tremors are not a sign of hyperbilirubinemia, but they may indicate other problems such as hypoglycemia, hypocalcemia, or seizures. Tremors are involuntary muscle movements that can affect different parts of the body.

Choice B reason:

Newborn rash, also known as erythema toxicum, is a common and harmless skin condition that affects many newborns. It causes red spots with white or yellow centers on the face, chest, back, or limbs. It is not related to hyperbilirubinemia or liver function.

Choice C reason:

Cephalohematoma is a collection of blood under the scalp that occurs due to trauma during delivery. It can increase the risk of hyperbilirubinemia because the breakdown of red blood cells in the hematoma releases bilirubin into the bloodstream. Bilirubin is a yellow pigment that is normally processed by the liver and excreted in stool and urine. If the liver is overwhelmed by the amount of bilirubin, it can cause jaundice, which is yellowing of the skin and eyes.

Choice D reason:

Acrocyanosis is a bluish discoloration of the hands and feet that occurs in some newborns due to poor circulation. It is usually a normal and transient phenomenon that does not indicate any serious problem. It is not a sign of hyperbilirubinemia or liver dysfunction.