A nurse is collecting data from a newborn who was delivered at 40 weeks of gestation.
Which of the following is an expected finding when eliciting reflexes from the newborn?

Choice A rationale

. Decreased urination, or oliguria, is typically associated with fluid volume deficit or impaired renal perfusion, not directly with uncomplicated hyperglycemia. In fact, hyperglycemia causes an osmotic diuresis because the excess glucose filtered by the glomeruli exceeds the renal tubules' reabsorption capacity. This results in the excretion of glucose, which draws water with it, leading to polyuria (increased urination), the opposite of the expected manifestation. Normal blood glucose is 70 to 100 mg/dL.

Choice B rationale

. Shallow respirations are not a characteristic sign of hyperglycemia in a client who is pregnant, unless the condition has progressed to severe diabetic ketoacidosis (DKA). DKA causes a metabolic acidosis, which triggers Kussmaul respirations—deep and labored breathing—as a compensatory mechanism to increase CO_2 elimination and raise the blood pH. Shallow breathing would decrease ventilation.

Choice C rationale

. Increased hunger, or polyphagia, is a classic manifestation of hyperglycemia due to the body's inability to utilize glucose effectively as an energy source, despite high blood glucose levels. The cells signal a state of starvation because glucose cannot enter the cells without sufficient insulin, prompting the release of neuropeptides that stimulate appetite and increased caloric intake.

Choice D rationale

. Increased thirst, or polydipsia, is a direct physiological response to the osmotic diuresis caused by hyperglycemia. The high concentration of glucose in the blood increases the plasma osmolarity, which pulls water from the intracellular space into the vascular space, causing cellular dehydration. This triggers the osmoreceptors in the hypothalamus, stimulating the sensation of thirst to encourage fluid intake.

Choice A rationale: Transitional stools indicate progression from meconium to normal infant stool, reflecting adequate feeding and gastrointestinal function. These stools are typically greenish-brown to yellow and appear within the first few days of life. Four stools in one shift suggest active peristalsis and effective bilirubin excretion via feces. This is a positive sign in managing hyperbilirubinemia, as bilirubin is eliminated through the gastrointestinal tract, supporting clinical improvement.

Choice B rationale: Dark yellow urine may suggest concentrated output, potentially indicating suboptimal hydration. While unchanged output may seem stable, the color implies reduced fluid intake or increased bilirubin excretion. In neonates, urine should be pale yellow if hydration is adequate. Persistent dark urine warrants follow-up to assess feeding adequacy and renal function. It is not a definitive sign of expected progression and may signal a need for increased fluid intake.

Choice C rationale: Clear lungs and absence of retractions indicate effective respiratory function and no signs of distress. Retractions are a compensatory mechanism for increased work of breathing, often seen in respiratory compromise. Their absence, along with clear auscultation, suggests normal pulmonary transition and oxygenation. This finding confirms that the newborn is adapting well postnatally, with stable respiratory status and no need for supplemental oxygen or intervention.

Choice D rationale: Softening of the edematous scalp area and presence of ecchymosis suggest resolution of birth trauma, likely a cephalohematoma from vacuum extraction. As blood reabsorbs, firmness decreases and bruising becomes more apparent. This progression is expected and indicates healing. Monitoring is still required for bilirubin levels due to hemolysis, but the physical changes reflect normal recovery from localized trauma without signs of infection or worsening.

Choice E rationale: A total serum bilirubin level of 14.2 mg/dL remains above the normal range (1 to 12 mg/dL) and indicates ongoing hyperbilirubinemia. Although it has decreased from the previous day’s 18.5 mg/dL, it still exceeds the threshold for concern. Continued phototherapy and monitoring are necessary. This value does not yet reflect full resolution, so it cannot be considered a sign of expected progression without further decline.

Choice F rationale: Facial bruising with yellow discoloration suggests ongoing breakdown of red blood cells and bilirubin deposition in the skin. While bruising may resolve over time, the yellowing indicates persistent jaundice. This is a sign of elevated bilirubin and not a marker of improvement. It requires continued phototherapy and monitoring. Therefore, it does not indicate expected progression and warrants follow-up.