Which newborn assessment finding would require the nurse to report to the health care provider?

The newborn who has cyanotic hands and feet.

The newborns whose head turns toward the cheek being stroked

The newborn whose toes curl when the lateral heel is stroked

The newborn who extends the arms when hearing a loud noise

Answer and Explanation

The Correct Answer is A

A. The newborn who has cyanotic hands and feetCyanosis, a bluish or purplish discoloration of the skin, in the hands and feet of a newborn can indicate a breathing problem or poor circulation. This requires prompt evaluation by a healthcare provider.
B. The newborn whose head turns toward the cheek being stroked. This describes the rooting reflex, which is normal.
C. The newborn whose toes curl when the lateral heel is stroked. This describes the Babinski reflex, which is also normal for infants.
D. The newborn who extends the arms when hearing a loud noise. This describes the Moro reflex, which is normal and should not require reporting.

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Correct Answer is B

Explanation

A. Once I am fitted for the diaphragm it will always be the correct size. Incorrect because weight changes, pregnancy, or pelvic surgery may require refitting.
B. I need to leave the diaphragm in for six hours after the last act of intercourse. This is correct to ensure that all sperm are inactivated.
C. This contraceptive can be used during menstruation. Incorrect because it's generally not recommended to use the diaphragm during menstruation due to increased risk of infection.
D. I can leave the diaphragm in for a day or two. Incorrect because leaving it in for more than 24 hours can increase the risk of infection, including toxic shock syndrome.

A. Review clotting studies lab report B. Notify the healthcare provider C. Document the findings in the electronic health record D. Report parents to Child Protective Services

Correct Answer is C

Explanation

A. Review clotting studies lab report: Not relevant to the assessment finding of a blue-gray discoloration.
B. Notify the healthcare provider: Unnecessary unless there are other concerning clinical findings.
C. Document the findings in the electronic health record: A blue-gray discoloration across the sacrum is likely a Mongolian spot, a benign condition more commonly seen in infants of Asian, African, Native American, and Hispanic descent. Documenting this finding in the electronic health record ensures accurate and comprehensive medical documentation without unnecessary interventions.
D. Report parents to Child Protective Services: Inappropriate as this finding is a benign condition common among certain ethnic groups and not indicative of abuse.

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Which newborn assessment finding would require the nurse to report to the health care provider?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

After educating a client on use of a diaphragm for contraception, which statement made by the client demonstrates an understanding of the teaching provided?

Correct Answer is B

Explanation

When performing an initial assessment on a full-term infant whose parents are Asian, the nurse notes a blue-gray discoloration across the sacrum of the newborn. What is the most appropriate action for the nurse to take?

Correct Answer is C

Explanation

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