A nurse is caring for a client who is at 37 weeks of gestation and reports a slow trickle of vaginal fluid for the past 12 hours.
Which of the following diagnostic tests should the nurse anticipate?

Choice A rationale

Erb-Duchenne palsy, a form of brachial plexus injury (C5-C6), primarily affects the nerves controlling the shoulder and upper arm muscles. It generally does not affect cranial nerves (such as IX and X, which control swallowing) or the muscles of the mouth, thus typically preserving the ability to suck and swallow.

Choice B rationale

The Moro (startle) reflex involves symmetrical extension and abduction of the arms followed by adduction and flexion. An injury to the brachial plexus on one side impairs the motor function of that arm, resulting in the characteristic absence of the reflex in the affected extremity, which is a key diagnostic finding.

Choice C rationale

The Babinski reflex is a normal neurological finding in infants up to about 2 years old, reflecting immature corticospinal tracts. It is a foot reflex and is unrelated to a brachial plexus injury in the neck and shoulder area; thus, its presence is not a specific finding for Erb-Duchenne palsy.

Choice D rationale

Cleft palate is a congenital craniofacial malformation resulting from incomplete fusion of the palatine shelves during fetal development. It is a structural anomaly of the mouth and is not a finding or complication associated with Erb-Duchenne palsy, which is a neuromuscular injury sustained, most commonly, during birth.

Choice A rationale

Newborns require substantial sleep for optimal growth and neurological development, often sleeping for 16 to 20 hours in a 24-hour period, though this varies. This is a normal physiologic finding, reflecting the rapid growth and high metabolic demands of infancy, and does not require immediate medical attention. The sleep is typically fragmented into short bouts.

Choice B rationale

Decreased urine output, specifically fewer than 6 to 8 wet diapers in 24 hours after the first few days of life, is a critical sign of dehydration and inadequate fluid intake, especially if the newborn is breastfed. This insufficient hydration can lead to hyperbilirubinemia, weight loss, and electrolyte imbalance, requiring prompt medical evaluation.

Choice C rationale

Newborn stools can normally be loose and frequent, especially in breastfed infants, who often pass stools several times a day. Stools in the first week progress from meconium to transitional to yellow, seedy, and loose, which is a normal finding and generally does not warrant contacting the provider unless signs of illness or diarrhea are present.

Choice D rationale

The umbilical cord stump usually dries and falls off within 1 to 3 weeks after birth due to a process of dry gangrene and separation. While most detach earlier, remaining attached after 1 week is still within the realm of normal variation and is not typically a cause for immediate concern unless signs of infection are present.