A nurse is collecting data from a newborn who is 48-hr old. Which of the following findings should the nurse report to the provider?
Erythema toxicum
Mongolian spot
Telangiectatic nevi
jaundice skin and yellow tinge to the sclera
The Correct Answer is D
Choice A rationale; Erythema toxicum is a common rash that appears in many newborns and is not a cause for concern. It presents as small red bumps or pustules on the skin and usually resolves on its own without treatment.
Choice B rationale: A Mongolian spot is a birthmark that appears as a bluish-gray or bruise-like patch on the baby's skin, often on the back or buttocks. It is a benign condition and does not require any medical intervention.
Choice C rationale: Telangiectatic nevi, also known as "stork bites" or "angel kisses," are flat, pink, or red birthmarks that are common in newborns. They are usually found on the eyelids, forehead, and back of the neck. These birthmarks are harmless and typically fade over time without treatment.
Choice D rationale: Jaundice is a common condition in newborns and is caused by elevated levels of bilirubin in the blood. In most cases, mild jaundice is not harmful and resolves on its own. However, if the baby's skin and sclera (white part of the eyes) show significant yellowing, it may indicate a higher level of bilirubin, which can lead to complications if not properly managed. Therefore, the nurse should report this finding to the provider for further evaluation and appropriate treatment if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["89.722"]
Explanation
To convert ounces to milliliters, we use the conversion factor: 1 oz = 29.5735 mL
0.5 oz = 0.5 * 29.5735 = 14.7868 mL (0800 feedings)
1 oz = 1 * 29.5735 = 29.5735 mL (1100 feeding)
0.5 oz = 0.5 * 29.5735 = 14.7868 mL (1300 feeding)
0.5 oz = 0.5 * 29.5735 = 14.7868 mL (1600 feeding)
0.5 oz = 0.5 * 29.5735 = 14.7868 mL (1830 feeding)
Total intake = 14.7868 + 29.5735 + 14.7868 + 14.7868 + 14.7868 = 89.722 mL
So, the nurse should record 89.722 mL of formula as the client's intake for the shift.
Correct Answer is B
Explanation
Choice A rationale: An increase in breast milk production is a normal physiological response during breastfeeding and does not indicate mastitis.
Choice B rationale: Mastitis is an inflammation of the breast tissue, usually caused by infection. It commonly occurs in breastfeeding women and is characterized by redness, warmth, swelling, and pain in one breast. The affected breast may also be tender and sore to the touch.
Choice C rationale: Swelling in both breasts is a common occurrence during the early days of breastfeeding as the milk supply adjusts to the baby's needs. It is not specific to mastitis.
Choice D rationale: Cracked and bleeding nipples can be a result of improper latch or positioning during breastfeeding, but they are not specific to mastitis.
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