The nurse should first address the client’s

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followed by the client’s

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.

Choice A rationale

Increased head circumference is an unexpected finding in a newborn exposed to cocaine in utero. Cocaine is a potent vasoconstrictor, which reduces blood flow and oxygen to the developing fetus, potentially leading to intrauterine growth restriction, which would more likely result in a smaller head circumference, not a larger one. This is due to compromised fetal oxygenation and nutrient delivery.

Choice B rationale

Hypotonicity, or decreased muscle tone, is not a typical finding. Neonates exposed to cocaine in utero often exhibit hypertonicity and a rigid posture due to central nervous system excitability. This increased muscle tone is a common neurological manifestation resulting from the drug's stimulatory effects on the developing nervous system, leading to hyperirritability and tremors.

Choice C rationale

Irritability is a very common finding in a newborn exposed to cocaine throughout pregnancy. Cocaine is a potent central nervous system stimulant, and its effects on the developing fetal brain can lead to long-term neurological and behavioral issues. After birth, the neonate experiences withdrawal symptoms, resulting in excessive crying, high-pitched cries, tremors, and a state of hypervigilance.

Choice D rationale

A decreased auditory startle response is not an expected finding. Newborns exposed to cocaine often exhibit an increased and exaggerated startle response to various stimuli, including auditory cues. This hyperresponsiveness is a manifestation of the generalized central nervous system excitability caused by the chronic prenatal exposure to the potent sympathomimetic effects of cocaine on the brain. *.

Choice A rationale

The ST segment represents the time from the end of ventricular depolarization to the beginning of ventricular repolarization. It is identified as the flat baseline following the QRS complex and preceding the T wave. This segment is isoelectric, meaning it's at the same level as the PR segment, and any deviation can indicate myocardial ischemia or injury.

Choice B rationale

The peak of the R wave represents the peak of ventricular depolarization. It signifies the moment of maximum electrical activity in the ventricles, as the impulse spreads through the ventricular walls. It is a critical point in the QRS complex, but it is not the location of the ST segment.

Choice C rationale

The beginning of the P wave marks the onset of atrial depolarization. This electrical event represents the contraction of the atria as they pump blood into the ventricles. The P wave is the first deflection in the cardiac cycle and occurs well before the QRS complex and the ST segment.

Choice D rationale

The interval between the S wave and the T wave is not a standard electrocardiographic term. The correct terminology is the ST segment, which is a segment, not an interval, and it specifically follows the S wave and precedes the T wave. An interval would typically include a wave, like the QT interval. *.