A nurse is caring for a client who experienced a vaginal birth 12 hours ago. The nurse recognizes the client is in the dependent, taking-in phase of maternal postpartum adjustment. Which of the following findings should the nurse expect during this phase?

Choice a reason:
Mongolian spots are a type of pigmented birthmark commonly found in newborns, often appearing as blue or grayish areas on the skin. They are not related to swelling and do not result from vacuum-assisted deliveries. Mongolian spots are usually located on the buttocks or lower back and are not associated with the type of swelling described by the mother.

Choice b reason:
Caput succedaneum is a condition where the newborn's scalp swells due to pressure during delivery. It is characterized by a soft, spongy mass that crosses suture lines and is most apparent on the part of the skull that was first to enter the birth canal. This condition is common in vacuum-assisted deliveries and is the correct explanation for the swelling observed on the newborn's head.

Choice c reason:
Erythema toxicum is a common and benign skin condition in newborns, presenting as red patches or small, fluid-filled bumps. It is not related to the swelling described and does not result from vacuum-assisted deliveries. Erythema toxicum typically resolves on its own and does not cause the type of swelling that crosses suture lines.

Choice d reason:
Cephalohematoma is a collection of blood between a newborn's scalp and the skull bone that results from ruptured blood vessels, which can be a result of birth trauma or pressure. However, it is typically confined to one area and does not cross suture lines. Since the swelling described by the mother crosses the suture lines, cephalohematoma is less likely to be the correct diagnosis.

Choice A reason:

The absence of vitamin K in newborns is a concern as it is essential for blood clotting. Newborns are at risk of vitamin K deficiency bleeding (VKDB), which can lead to serious bleeding issues but not typically jaundice. VKDB is preventable with a vitamin K injection at birth.

Choice B reason:

Physiologic jaundice is common in newborns and usually appears between the second and fourth day after birth. It occurs due to the baby's liver not being mature enough to get rid of bilirubin in the bloodstream. This type of jaundice is generally harmless and resolves on its own within two weeks.

Choice C reason:

Maternal cocaine abuse can have numerous adverse effects on a newborn, including premature birth and withdrawal symptoms, but it does not directly cause jaundice. The symptoms of cocaine exposure in newborns can include tremors, muscle spasms, and difficulty feeding.

Choice D reason:

Blood group incompatibility, such as Rh disease or ABO incompatibility, can lead to hemolytic disease of the newborn (HDN), which can cause jaundice. This occurs when the mother's antibodies attack the baby's red blood cells, leading to increased bilirubin levels.