The following newborns are three-hours old and are sleeping.
The registered nurse should notify the provider about which newborn?

Choice A rationale

Blue-gray discolorations on the sacrum, commonly known as Mongolian spots, are benign skin markings that frequently appear in newborns of Asian, African, and Hispanic descent. Documenting this finding ensures accurate medical records and prevents misinterpretation of these congenital marks as bruising.

Choice B rationale

There is no need to notify the healthcare provider about Mongolian spots unless there is uncertainty regarding their origin. These spots are non-pathological and typically fade within the first years of life, requiring no medical intervention or immediate attention.

Choice C rationale

Clotting studies are unnecessary for blue-gray discoloration because Mongolian spots are not related to blood clotting disorders. They are caused by the accumulation of melanocytes in the dermis during fetal development, a harmless pigmentation phenomenon.

Choice D rationale

Reporting parents to Child Protective Services in this context would be inappropriate and unjustified. Mongolian spots are a common and well-documented congenital skin feature, not indicative of abuse, and misinterpreting them could lead to undue stress and harm to the family. .

Choice A rationale

A history of breast cancer is a contraindication for menopausal hormone therapy (HT) due to its potential to stimulate hormone receptor-positive cancer cells. Estrogen, a component of HT, may promote the growth of residual malignant cells. HT must be avoided to minimize the recurrence risk. Regular screening and alternative symptom management are recommended for these patients.

Choice B rationale

GERD management with proton pump inhibitors or H2 receptor antagonists does not contraindicate HT. These conditions are unrelated to hormone therapy risks or benefits. HT may even aid in esophageal mucosal protection in some menopausal women, but only under clinical evaluation.

Choice C rationale

Dermatitis, being a localized skin condition, has no direct correlation to HT contraindications. While some patients may report worsened symptoms with HT, it is not a standard exclusion criterion. Hormone therapy decisions should focus on systemic and oncological considerations rather than minor dermatologic history.

Choice D rationale

COPD, while a chronic respiratory condition, is not a standard contraindication for HT. Careful evaluation of cardiopulmonary status is necessary before initiating HT, as estrogen may influence thromboembolic risk, particularly in sedentary individuals, but it is not specifically contraindicated in COPD cases.