The new mother of a 2-day-old neonate who weighed 8 pounds at birth is distressed that the baby has lost one-half pound. The home health nurse's response is one of:
Alertness as such weight loss is not expected
Reassurance as this is a normal weight loss
Alarm as this is a drastic weight loss
Concern as this may be an indicator of inadequate nutrition
The Correct Answer is B
A. Alertness as such weight loss is not expected: This response may unnecessarily alarm the mother when, in fact, some weight loss in the early days is normal.
B. Reassurance as this is a normal weight loss.
It is normal for newborns to lose some weight during the first few days of life. The loss is often related to fluid loss, changes in feeding patterns, and initial adjustment to life outside the womb. A loss of one-half pound in a 2-day-old neonate is generally considered within the normal range. It's important for the nurse to reassure the new mother that this weight loss is expected and not a cause for alarm. Newborns typically start to regain their birth weight within a week or two. This reassurance can help ease the mother's distress and anxiety.
C. Alarm as this is a drastic weight loss: Characterizing this weight loss as "drastic" is not accurate or helpful and would likely increase the mother's anxiety.
D. Concern as this may be an indicator of inadequate nutrition: Jumping to the conclusion of inadequate nutrition without further assessment and evidence is premature and may unnecessarily worry the mother. It's important to start with reassurance and then investigate if there are concerns about nutrition.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
A. Inspecting the mouth weekly for ulcerations is not sufficient. Children receiving chemotherapy should be encouraged to perform daily oral care, and any concerning symptoms should be reported promptly to the healthcare provider.
B. Using a potent commercial mouthwash is not recommended, as many commercial mouthwashes contain alcohol or other potentially irritating ingredients. A healthcare provider should recommend a suitable oral rinse if needed.
C. Clean the teeth manually with a soft toothbrush.
Children receiving chemotherapy are at risk of developing mouth sores (mucositis) and other oral complications. It is essential to maintain good oral hygiene to minimize the risk of infection and reduce discomfort. Using a soft toothbrush for gentle manual cleaning is recommended, as it helps to prevent injury to the sensitive oral tissues that can occur with a hard toothbrush.
D. Visiting a dental professional only during episodes of excessive bleeding or pain is not recommended. Regular dental check-ups are important for children receiving chemotherapy to monitor and address oral health issues. Waiting for symptoms of bleeding or pain may result in a delay in addressing potential problems.
Correct Answer is A
Explanation
A white glow of the pupil, often referred to as "cat's eye reflex" or "leukocoria," is a significant and characteristic sign of retinoblastoma. It occurs when the tumor within the eye reflects light, resulting in a white or yellowish glow in the pupil when light is shined into it. This can be seen in flash photographs or in certain lighting conditions. It's a crucial sign that may indicate the presence of retinoblastoma, a rare eye cancer that primarily affects young children.
The other options, B (ptosis of the eye), C (fixed and dilated pupil), and D (purulent eye discharge), are not typically associated with retinoblastoma. Ptosis is the drooping of the upper eyelid, a fixed and dilated pupil is usually a sign of neurological issues, and purulent eye discharge is often associated with eye infections rather than retinoblastoma.
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