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. Drying the newborn's skin thoroughly helps to reduce evaporative heat loss by removing moisture from the skin's surface, which decreases heat loss through evaporation.
B. Maintaining ambient room temperature at 24°C (75°F) helps to prevent hypothermia but does not directly address evaporative heat loss.
C. Preventing air drafts is important for reducing convective heat loss but does not specifically target evaporative heat loss.
D. Placing the newborn on a warm surface helps to prevent conductive heat loss but does not directly address evaporative heat loss.
Correct Answer is B
Explanation
A. Educating the parents about the defect is important for their understanding and involvement in the care of the newborn, but it is not the priority when the infant has a myelomeningocele.
B. Maintaining the integrity of the sac is the priority goal in the care of a newborn with myelomeningocele to prevent infection and protect the exposed neural tissue.
C. Providing age-appropriate stimulation is important for the overall development of the newborn but is not the priority when the infant has a myelomeningocele.
D. Promoting maternal-infant bonding is essential for the emotional well-being of both the
mother and the newborn, but it is not the priority when immediate physical care needs exist, such as maintaining the integrity of the sac.
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