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A nurse is preparing to assess a newborn who is postmature.
Which of the following findings should the nurse expect? (Select all that apply.)

A.

Abundant lanugo

B.

Positive Moro reflex

C.

Vernix in the folds and creases

D.

Short, soft fingernails

E.

Cracked, peeling skin

Answer and Explanation

Correct Answer : B,E

Choice A rationale
Abundant lanugo, which is fine hair, is not typically seen in postmature babies. It is more common in babies who are born prematurely.
Choice B rationale
A positive Moro reflex is a normal finding in newborns, including those who are postmature, indicating a healthy neurological response.
Choice C rationale
Vernix, a white creamy substance that protects the baby’s skin in the womb, is usually absent or very scant in postmature babies.
Choice D rationale
Short, soft fingernails are not a specific sign of postmaturity. Newborns’ fingernails can vary, and they often grow quickly after birth.
Choice E rationale
 

Cracked, peeling skin is commonly seen in postmature babies. Their skin can often appear dry and wrinkled.
 


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Related Questions

Correct Answer is B

Explanation

Choice A rationale
While the hepatitis B vaccine is an important part of preventing hepatitis B infection, it is not typically given on a monthly basis until the newborn tests negative for the hepatitis B surface antigen. Instead, the vaccine is usually given in a series of three to four doses over a six-month period.
Choice B rationale
For newborns who test positive for the hepatitis B surface antigen, the current recommendation is to administer both the hepatitis B immune globulin (HBIG) and the

hepatitis B vaccine within 12 hours of birth. The HBIG provides immediate, short-term protection against the virus, while the vaccine stimulates the newborn’s immune system to provide long-term protection.
Choice C rationale
While the hepatitis B immune globulin (HBIG) and the hepatitis B vaccine are both important for preventing hepatitis B infection in newborns, they are not typically administered in the manner described in this choice. The HBIG is usually given once, within 12 hours of birth, while the vaccine is given in a series of three to four doses over a six-month period.
Choice D rationale
The hepatitis B vaccine is typically given within 24 hours of birth, but it is not followed by doses of the hepatitis B immune globulin (HBIG) every 12 hours for three days. Instead, a single dose of HBIG is usually given within 12 hours of birth, along with the first dose of the vaccine.

Correct Answer is A

Explanation

The nurse should first assess the fundus of the uterus. If the uterus is not firm (boggy), it may not be contracting well enough to compress the blood vessels and stop the bleeding. The nurse should massage the fundus until it is firm.

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