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.”
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.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
A. Crayons and a coloring book: While coloring activities can be enjoyable and stimulating for toddlers, they may not be suitable for a hospitalized toddler in a confined room with contact precautions. Additionally, crayons and coloring materials may pose infection control risks.
B. Hanging crib toys: Hanging crib toys, such as mobiles or activity centers that attach to the crib, are suitable for stimulating visual and motor development in infants. They can provide entertainment and sensory stimulation for a hospitalized toddler in a confined room.
C. Large building blocks: Large building blocks are more suitable for older toddlers who have developed fine motor skills and coordination. They may not be appropriate for a 12-month-old toddler who is just beginning to explore objects and manipulate toys.
D. Modeling clay: Modeling clay presents a choking hazard and may not be suitable for a toddler who is still in the oral exploration stage. It is important to select toys that are age-appropriate and safe for a hospitalized toddler's developmental stage.
Correct Answer is B
Explanation
A. Use quick deliberate gestures to get your point across.
Using quick gestures may intimidate or overwhelm the child, potentially hindering communication. It's essential to approach the child with patience and attentiveness.
B. Allow the child to control the pace and order of the health history.
Allowing the child to dictate the pace and sequence of the health history empowers them and helps build trust. It allows the child to express themselves comfortably and share relevant
information at their own pace.
C. Do not make physical contact with the child during the interview.
While respecting the child's personal space is important, appropriate physical contact, such as a reassuring touch or handshake, can help establish rapport and comfort during the interview.
D. Wear a white examination coat when conducting the interview.
Wearing a white coat may create a sense of formality and authority that could intimidate the child. Opting for attire that is approachable and friendly can help put the child at ease and facilitate open communication.
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