A nurse is caring for a newborn
The newborn is at highest risk of developing
The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"A"}
- Hyperbilirubinemia is a concern due to the presence of cephalohematoma (a firm, edematous area on the scalp that does not cross suture lines) and yellow sclera, both of which are indicators of increased bilirubin from red blood cell breakdown.
- The head assessment reveals these findings (scleral icterus and cephalohematoma), which directly support the risk.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. It is normal for the newborn’s cord stump to remain attached for up to 1-2 weeks.
B. Newborns typically sleep 16-20 hours per day, so this is expected.
C. Fewer than four wet diapers in 24 hours can indicate inadequate hydration or feeding and requires immediate evaluation.
D. Loose stools are common in breastfed newborns and are generally not concerning.
Correct Answer is B
Explanation
A. A grade 2 placental abruption typically presents with a firm or rigid abdomen due to concealed bleeding, not a soft one.
B. Maternal tachycardia (heart rate 120/min) is expected due to blood loss and compensatory response to hypovolemia.
C. A fetal heart rate of 150/min with moderate variability is a reassuring sign and would not typically be expected in a significant abruption, where fetal distress is more common.
D. Vaginal bleeding from placental abruption is typically painful, and may be concealed. Painless bleeding is more characteristic of placenta previa.
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