A nurse is completing a newborn gestational age assessment. Which of the following findings should be recorded as part of this assessment on the newborn?
Plantar creases cover 2/3 of sole
Acrocyanosis of hands and feet
Anterior fontanel soft and level
Vernix caseosa in inguinal creases
The Correct Answer is A
- A: Plantar creases covering 2/3 of the sole is indicative of a more mature newborn, which is a significant finding in assessing gestational age.
- B: Acrocyanosis of hands and feet is a common finding in the first few days after birth and is not specifically related to gestational age.
- C: The condition of the anterior fontanel being soft and level is a normal finding and does not contribute to the assessment of gestational age.
- D: The presence of vernix caseosa in inguinal creases can be seen in both preterm and full-term newborns, thus it is not a specific indicator of gestational age.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
A. The nurse's response to have the mother call ensures proper protocol is followed for infant transfer and prioritizes the mother's consent, making it the safest option.
B. While checking identification is important, it does not establish proper protocol for transferring the infant and may not address whether the mother has authorized the transfer.
C. Allowing the grandmother to carry the grandchild without confirming the mother's wishes could lead to security and safety concerns, making this response inappropriate.
D. Allowing the grandmother to push the baby in a wheeled bassinet is not the standard practice; the nurse should ensure that the baby is safely transported by hospital staff.
Correct Answer is C
Explanation
A. Applying cold compresses is not indicated for pain and redness of the calf, which may
indicate deep vein thrombosis (DVT). Cold therapy is not recommended as it can worsen the condition.
B. Massaging the area is contraindicated in suspected DVT as it can dislodge a clot and lead to complications such as pulmonary embolism.
C. Elevating her leg helps to reduce swelling and improve venous return, which can alleviate symptoms of DVT and prevent further complications.
D. Flexing her knee while resting is not specifically indicated for the management of suspected DVT and may not address the underlying cause of pain and redness in the calf.
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