The nurse is conducting a newborn assessment and identifies a collection of blood beneath the newborn’s scalp that does not cross the suture lines.
How should the nurse document this finding?

Occiput posterior.

Caput succedaneum.

Cephalohematoma.

Sinciput.

Answer and Explanation

The Correct Answer is C

Choice A rationale
Occiput posterior is a term used to describe the position of the baby’s head during labor and delivery, not a condition related to a collection of blood beneath the newborn’s scalp.
Choice B rationale
Caput succedaneum refers to a localized swelling of the scalp of a newborn caused by pressure on the head during delivery. It is not limited by suture lines and usually resolves within a few days.
Choice C rationale
Cephalohematoma is a collection of blood under the scalp of a newborn baby, specifically between the scalp and the skull, and does not cross the suture lines. It is usually caused by minor trauma to the head during childbirth.
Choice D rationale
Sinciput is a term used to describe the part of the fetal head that is presented first in childbirth, not a condition related to a collection of blood beneath the newborn’s scalp.

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Correct Answer is D

Explanation

Choice A rationale
Cocaine use is a risk factor for placental abruption, but it is not the most common one. Cocaine can cause vasoconstriction and decrease placental perfusion, leading to abruption.
Choice B rationale
Blunt force trauma, such as that from a car accident or physical violence, can cause placental abruption. However, it is not the most common risk factor.
Choice C rationale
Cigarette smoking is a risk factor for many pregnancy complications, including placental abruption. Smoking can impair placental function and lead to poor pregnancy outcomes.
Choice D rationale
Hypertension is the most common risk factor for placental abruption. High blood pressure can cause damage to the blood vessels in the placenta, leading to abruption.

A. Deep tendon reflexes of +1. B. 3+ protein in the urine. C. Blood pressure 148/98 mm Hg. D. 1+ pitting sacral edema.

Correct Answer is A

Explanation

Choice A rationale
Deep tendon reflexes of +1 are not consistent with preeclampsia. Preeclampsia is often associated with hyperreflexia, which would be a deep tendon reflex of +3 or +467.
Choice B rationale
3+ protein in the urine is consistent with preeclampsia. Proteinuria is a common finding in preeclampsia due to kidney involvement.
Choice C rationale
Blood pressure 148/98 mm Hg is consistent with preeclampsia. Hypertension is a key feature of preeclampsia.
Choice D rationale
1+ pitting sacral edema is consistent with preeclampsia. Edema, particularly in the face and hands, is a common finding in preeclampsia.

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The nurse is conducting a newborn assessment and identifies a collection of blood beneath the newborn’s scalp that does not cross the suture lines. How should the nurse document this finding?

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Naxlex Comprehensive Predictor Exams

A nurse in a provider’s office is caring for a client who is at 34 weeks of gestation and at risk for placental abruption. Which of the following is the most common risk factor for abruption?

Correct Answer is D

Explanation

A nurse is caring for an adolescent client who is gravida 1 and para 0. The client was admitted to the hospital at 38 weeks of gestation with a diagnosis of preeclampsia. Which of the following findings should the nurse identify as inconsistent with preeclampsia?

Correct Answer is A

Explanation

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The nurse is conducting a newborn assessment and identifies a collection of blood beneath the newborn’s scalp that does not cross the suture lines.
How should the nurse document this finding?