A nurse is performing an assessment of a newborn's Babinski reflex. Which of the following findings should the nurse expect?
Flexion of the forearm.
Downward curl of the toes.
Dorsiflexion of the great toe.
Extension of the leg.
The Correct Answer is C
The Babinski reflex, also known as the plantar reflex, is a normal reflex in infants
that occurs when the sole of the foot is stroked from heel to toe.
In response to this stimulus, the big toe moves upward or toward the top surface of the foot and the other toes fan out.
Choice A is not an answer because flexion of the forearm is not a response to stimulation of the foot.
Choice B is not an answer because downward curl of the toes is not a response
to stimulation of the foot.
Choice D is not an answer because extension of the leg is not a response to
stimulation of the foot.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
The first action the nurse should take is to apply identification bands to the newborn (choice D).
This is an important step in ensuring the safety and security of the newborn and helps to prevent errors such as misidentification.
Choices A, B, and C are also important actions that should be taken when caring for a newborn following delivery.
However, applying prophylactic eye ointment (choice A), administering vitamin K (choice B), and obtaining the newborn’s weight (choice C) can be done after the identification bands have been applied.
Correct Answer is B
Explanation
The nurse should report a fundal height of 38 cm to the provider.
Fundal height is measured from the top of the pubic bone to the top of the uterus and is used to assess fetal growth.
A fundal height measurement that is larger than expected for gestational age may indicate macrosomia, which is a common complication of gestational diabetes mellitus.
Choice A is incorrect because non-pitting pedal edema is common during late pregnancy and is usually caused by physiologic edema resulting from hormone- induced sodium retention.
Choice C is incorrect because 12 fetal movements in an hour are within normal
range.
Choice D is incorrect because a fasting blood glucose level of 90 mg/dL is within normal range for a pregnant woman with gestational diabetes mellitus.
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