Which newborn reflex elicits the following reaction: Head turns to one side - the way the head is facing, the arm/leg is stretched out while the other is bent?
Tonic neck reflex.
Moro reflex.
Startled reflex.
Babinski reflex.
The Correct Answer is A
Choice A reason:
The tonic neck reflex, also called the fencing posture, occurs when a baby's head is turned to one side. The arm and leg on that side stretch out, while the opposite arm and leg bend up at the elbow. This reflex lasts until the baby is about 5 to 7 months old. This reflex matches the description of the question.
Choice B reason:
The Moro reflex, also called the startle reflex, is the baby's reaction to being startled. The cause is often a loud sound, a sudden movement, or even their own cry. As an adult, you may jump or gasp when you are startled. A baby will throw back their head, extend their arms and legs, cry, then pull their arms and legs back in. This reflex does not match the description of the question.
Choice C reason:
The startled reflex is not a distinct reflex in newborns. It is another name for the Moro reflex, which is explained.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A: the interval between contractions
Encouraging a laboring woman to push during the interval between contractions is not appropriate. During this time, the uterus is not contracting, and pushing would be ineffective and exhausting for the woman. The intervals are meant for rest and recovery to prepare for the next contraction.
Choice B: whenever she feels the need
While it is important to listen to the laboring woman’s instincts, pushing should be coordinated with contractions for maximum effectiveness. Pushing whenever she feels the need might not align with the contractions, leading to ineffective efforts and increased fatigue.
Choice C: second-stage of labor
The second stage of labor is the most appropriate time for the nurse to encourage a laboring woman to push. This stage begins when the cervix is fully dilated to 10 centimeters and ends with the birth of the baby. During this stage, contractions are strong and frequent, providing the necessary force to help push the baby through the birth canal.
Choice D: first-stage of labor
The first stage of labor involves the dilation and effacement of the cervix and is not the appropriate time for pushing. Pushing during this stage can cause unnecessary strain and may lead to complications. The focus during the first stage should be on managing contractions and conserving energy for the second stage.
Correct Answer is C
Explanation
The correct answer is c. Dehydration. A significantly indented anterior fontanelle in a newborn is most commonly a sign of dehydration.
Choice A reason:
Increased intracranial pressure: This statement is incorrect because increased intracranial pressure typically causes a bulging, not indented, fontanelle. Symptoms include irritability, vomiting, and a high-pitched cry.
Choice B reason:
Vernix caseosa: This statement is incorrect because vernix caseosa is a white, cheesy substance covering the skin of newborns, unrelated to fontanelle indentation. It serves as a protective layer for the baby’s skin.
Choice C reason:
Dehydration: This statement is correct. Dehydration in newborns can cause a sunken fontanelle due to the loss of fluid. Other signs include dry mouth, sunken eyes, and fewer wet diapers.
Choice D reason:
Cyanosis: This statement is incorrect because cyanosis refers to a bluish discoloration of the skin due to lack of oxygen, not related to fontanelle shape. It indicates issues with oxygenation or circulation.
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