A nurse is conducting an initial assessment of a newborn delivered with a nuchal cord. What clinical findings should the nurse anticipate?
Facial petechiae
Erythema toxicum
Periauricular papillomas
Telangiectatic nevi
The Correct Answer is A
Choice A rationale
Facial petechiae are small, pinpoint, red or purple spots on the skin that can occur when a newborn has a nuchal cord, or the umbilical cord wrapped around the neck. This is due to the pressure exerted on the baby’s face and neck during delivery.
Choice B rationale
Erythema toxicum is a common rash seen in newborns, characterized by tiny bumps surrounded by red skin. However, it is not specifically associated with a nuchal cord.
Choice C rationale
Periauricular papillomas are small skin tags or pits seen near the ear. They are a common minor anomaly seen in newborns, but they are not associated with a nuchal cord.
Choice D rationale
Telangiectatic nevi, also known as “stork bites,” are common birthmarks seen in newborns, characterized by small, light pink patches, usually on the back of the neck. However, they are not associated with a nuchal cord.
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Related Questions
Correct Answer is D
Explanation

The correct answer is choice d. Transmission can occur via the saliva and urine of the newborn.
Choice A rationale:
Lesions are not typically visible on the mother’s genitalia with cytomegalovirus (CMV) infection. CMV is often asymptomatic or presents with nonspecific symptoms, and visible lesions are not a characteristic feature.
Choice B rationale:
CMV does not require airborne precautions. It is primarily transmitted through direct contact with bodily fluids such as saliva, urine, blood, and breast milk.
Choice C rationale:
Prophylactic treatment with acyclovir is not standard for CMV. Acyclovir is used for herpes simplex virus infections, not CMV.
Choice D rationale:
CMV can indeed be transmitted via the saliva and urine of the newborn. This is a common mode of transmission, especially in settings like daycare centers where young children are in close contact.
Correct Answer is A
Explanation
Choice A rationale
It is crucial to confirm that informed consent has been obtained before administering a dinoprostone insert to induce labor. This is because the patient has the right to understand the benefits, risks, and alternatives of the procedure before it is performed.
Choice B rationale
Positioning the client in a semi-Fowler’s position for 1 hour after administration is not necessary. After the dinoprostone insert is placed, the patient should remain lying down for at least 30 minutes. After this, the patient may sit up or walk, being careful to ensure the insert remains in place.
Choice C rationale
Allowing the medication to reach room temperature before administration is not a requirement for dinoprostone insert. The medication can be administered as soon as it is needed.
Choice D rationale
Advising the client to avoid urinating until after administration is not necessary. The patient can urinate as needed after the dinoprostone insert is placed.
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