Which of the following findings in the newborn's electronic medical record (EMR) are risk factors for the newborn to develop a complication? (Select all that apply.)
Weight.
Type of birth.
Apgar scores.
Gestational age.
Heart sounds.
Length.
Correct Answer : B,C,D
Choice A rationale
The newborn's weight is an important metric used to assess appropriate growth. While deviations (e.g., small for gestational age or large for gestational age) are risk factors, the mere recording of the weight itself in the EMR is a standard measurement, not inherently a risk factor. It becomes a risk factor only when the measurement falls outside the expected range for the newborn's gestational age.
Choice B rationale
The type of birth (e.g., vaginal, Cesarean section) is a risk factor for complications. Cesarean birth, especially without labor, is associated with an increased risk of transient tachypnea of the newborn (TTN) due to retained fetal lung fluid. Conversely, a prolonged or operative vaginal birth can increase the risk of birth trauma, suggesting the type of birth itself introduces specific complication risks.
Choice C rationale
Apgar scores are a rapid assessment of five physiological signs (Appearance, Pulse, Grimace, Activity, Respiration) at one and five minutes of life. A low Apgar score (typically ≤ 7 at five minutes) is a significant and immediate indicator of neonatal distress and a strong risk factor for long-term neurological complications, necessitating prompt and potentially intensive resuscitation.
Choice D rationale
Gestational age is a primary determinant of neonatal maturity and viability. Preterm birth (less than 37 weeks) is a major risk factor for complications, including respiratory distress syndrome (due to surfactant deficiency), thermoregulation difficulties, and developmental issues. Post-term birth (over 42 weeks) is also a risk for placental insufficiency and meconium aspiration.
Choice E rationale
The recording of heart sounds in the EMR is part of a standard newborn physical assessment. The presence of a normal finding (e.g., regular rhythm, no murmurs) is a sign of health, not a risk factor. An abnormal finding, such as a persistent murmur suggestive of a congenital heart defect, would be the risk factor, but the standard documentation is just a physiological assessment.
Choice F rationale
The newborn's length is a standard anthropometric measurement, assessing overall growth and proportional development. Like weight, recording the length itself is a standard parameter, not a risk factor. It only becomes clinically significant as an indicator of an underlying issue if it is disproportionate or falls significantly outside the expected percentile range for the newborn's gestational age.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is D
Explanation
Choice A rationale
While the date of birth is essential information, asking a parent to state it only provides a detail from the medical record, which does not serve as a primary security confirmation of the newborn's identity for safe transport. The primary identification security relies on matching identifiers between the infant and the parent/guardian at the bedside.
Choice B rationale
The newborn's name is recorded in the medical record after birth, but verbal verification of the name alone is not a fail-safe security measure. Identification protocols require objective data comparison, such as unique numbers on corresponding identification bands, to prevent accidental mismatches and potential abduction.
Choice C rationale
The newborn's footprint sheet is typically used as a permanent record for identification purposes but is not the standard, immediate bedside method for confirming identity before transport. The process requires a direct comparison of unique numerical identifiers on the physical bands worn by the client and the newborn.
Choice D rationale
The most secure method is comparing the unique identification numbers (or codes) on the newborn's band with the band worn by the parent/guardian. This dual-band system, verified by the nurse and the parent, ensures positive identification and is a critical safety protocol to prevent misidentification and potential infant abductions.
Correct Answer is B
Explanation
Choice A rationale
A late preterm newborn (born between 34 0/7 and 36 6/7 weeks of gestation) often exhibits periods of alertness, but they are also commonly noted to have a sleepy, less sustained alert state compared to a full-term neonate. Their neurological immaturity contributes to poor state regulation and a less vigorous overall response.
Choice B rationale
Thermal instability is an expected finding in late preterm newborns because they have less subcutaneous fat (insulation) than term infants, a higher surface area-to-volume ratio, and immature hypothalamic temperature regulation. This increased vulnerability necessitates careful monitoring and environmental thermoregulation (normal axillary temperature: 36.5°C to 37.3°C).
Choice C rationale
Late preterm newborns are at an increased risk of hypoglycemia (serum glucose ≤ 40 mg/dL) due to inadequate glycogen stores, increased metabolic demands, and immature gluconeogenesis pathways. Hyperglycemia (serum glucose ≥ 125 mg/dL) is not typically expected unless the infant is under high stress or receiving high glucose infusions.
Choice D rationale
Leathery or cracked, dry skin is characteristic of a post-term newborn (born after 42 weeks) due to prolonged exposure to amniotic fluid and desiccation. Late preterm newborns have relatively thin, smooth skin with visible blood vessels because the subcutaneous fat layer is not yet fully developed.
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