The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond?

“This is a vasomotor response caused by cooling or warming."

“This is normal her circulatory system will take a few days to adjust.”

"Let's watch her carefully to make sure she does not have a circulatory problem."

"Your daughter has acrocyanosis; this is causing her blue hands and feet.”

Answer and Explanation

The Correct Answer is D

A. “This is a vasomotor response caused by cooling or warming": While vasomotor responses can cause changes in skin color due to temperature changes, acrocyanosis specifically refers to blue discoloration of the hands and feet due to reduced peripheral circulation, not necessarily due to temperature changes.

B. “This is normal her circulatory system will take a few days to adjust”: While it's true that newborns may have transient circulatory changes as their circulatory system adapts after birth, acrocyanosis specifically refers to a benign condition characterized by persistent blue discoloration of the extremities unrelated to circulatory adjustments.

C. "Let's watch her carefully to make sure she does not have a circulatory problem": While it's important to monitor infants for any signs of circulatory problems, acrocyanosis is typically a

benign and self-limiting condition that does not require intervention unless accompanied by other concerning symptoms.

D. "Your daughter has acrocyanosis; this is causing her blue hands and feet.”: This response provides an accurate explanation for the blue discoloration of the infant's hands and feet. Acrocyanosis is a common and benign condition in newborns characterized by blue discoloration of the extremities due to peripheral vasoconstriction, which gradually resolves over the first few days to weeks of life.

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Correct Answer is C

Explanation

A. A Jewish male. While certain genetic factors may predispose individuals to hypertension, ethnicity or religious affiliation alone is not a direct risk factor for hypertension. Screening for hypertension should be based on individual risk factors and not solely on ethnicity or religion.

B. A white male. While hypertension can affect individuals of any race or ethnicity, it is less prevalent among white populations compared to African-American populations. However, hypertension can still occur in white males, especially if they have other risk factors such as obesity, family history, or unhealthy lifestyle habits.

C. An African-American male. African-American individuals, particularly males, have a higher prevalence of hypertension compared to other racial and ethnic groups. Genetic predisposition, as well as socio-economic factors and healthcare disparities, contribute to this increased risk.

Therefore, it is important to screen African-American males for hypertension, starting from adolescence, to ensure early detection and management.

D. An Asian female. While hypertension can affect individuals of Asian descent, the prevalence is generally lower compared to other racial and ethnic groups such as African-Americans. However, certain subgroups within the Asian population, such as South Asians, may have higher rates of hypertension due to genetic and lifestyle factors. Screening for hypertension should be based on individual risk factors rather than broad racial or ethnic categories.

A. Speak to the child using mature language and appeal to his or her desire for self-care. B. Include the child in all parts of the examination: speak to the caregiver before and after the examination. C. Keep up a running dialogue with the caregiver, explaining each step as you do it. D. Address the child by name; speak to the caregiver and do the most invasive parts last.

Correct Answer is A

Explanation

A. Speak to the child using mature language and appeal to his or her desire for self-care. - School-age children are typically more independent and responsive to mature communication. Acknowledging their desire for self-care fosters cooperation during the examination process.

B. Include the child in all parts of the examination: speak to the caregiver before and after the examination. - While involving the child in the examination process is important, school-age children may prefer direct communication rather than primarily interacting with caregivers.

C. Keep up a running dialogue with the caregiver, explaining each step as you do it. - While

involving caregivers in the examination process is important, maintaining a dialogue primarily with them may not fully engage the child during the assessment.

D. Address the child by name; speak to the caregiver and do the most invasive parts last. - While considering the child's comfort and addressing them directly is essential, school-age children

may respond better to direct communication rather than deferring to caregivers for discussion

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The parents of a 2-day-old girl are concerned because her feet and hands are slightly blue. How should the nurse respond?

Nursing Test Bank

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Correct Answer is C

Explanation

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Correct Answer is A

Explanation

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