Which of the following observations should be recorded as part of a newborn gestational age assessment?

Anterior fontanel soft and level.

Plantar creases cover 3 of the sole.

Acrocyanosis of hands and feet.

Vernix caseosa in inguinal creases

Answer and Explanation

The Correct Answer is B

Choice A rationale
While the anterior fontanel being soft and level is an important observation in a newborn, it is not typically used as part of a gestational age assessment.
Choice B rationale
The presence of plantar creases covering 3 of the sole is a typical finding in a full-term newborn and is used as part of a gestational age assessment.
Choice C rationale
Acrocyanosis, or bluish discoloration of the hands and feet, is a common finding in newborns, especially shortly after birth. However, it is not typically used as part of a gestational age assessment.
Choice D rationale
Vernix caseosa in the inguinal creases can be a sign of a preterm newborn, as vernix caseosa is typically present in larger amounts in preterm newborns. However, it is not typically used as part of a gestational age assessment.

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Correct Answer is C

Explanation

Choice A rationale
Assessing her skin for hydration and color can provide some information about the client’s overall health and nutritional status, but it doesn’t directly assess her diet.
Choice B rationale
Assessing a list she makes describing a good diet can provide information about the client’s knowledge of nutrition, but it doesn’t provide information about her actual dietary intake.
Choice C rationale
Asking her to describe her intake for the last week can provide a more accurate picture of her actual dietary habits and nutritional status.
Choice D rationale
Asking her to describe her total intake for a week during pregnancy can provide information about her dietary habits during pregnancy, but it doesn’t assess her current diet.

A. There is an increased risk of introducing infection. B. This could initiate preterm labor. C. This could result in profound bleeding. D. There is an increased risk of rupture of the membranes.

Correct Answer is C

Explanation

Choice A rationale
While it’s true that any internal examination carries a risk of introducing infection, this is not the primary reason to avoid an internal examination in a client with placenta previa.
Choice B rationale
Initiating preterm labor is a concern with any internal examination, but it’s not the primary reason to avoid an internal examination in a client with placenta previa.
Choice C rationale
This is the correct answer. In a client with placenta previa, an internal examination could disturb the placenta and cause severe, potentially life-threatening bleeding.
Choice D rationale
While rupture of the membranes is a risk associated with internal examinations, it’s not the primary reason to avoid an internal examination in a client with placenta previa.

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Which of the following observations should be recorded as part of a newborn gestational age assessment?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

What is the role of a nurse in assessing a pregnant woman’s diet?

Correct Answer is C

Explanation

A nurse is caring for a client who is at 37 weeks of gestation and has placenta previa. The client asks the nurse why the provider does not do an internal examination.Which of the following explanations of the primary reason should the nurse provide?

Correct Answer is C

Explanation

A nurse is assisting a client with breastfeeding. The nurse explains that which of the following reflexes will promote the newborn to latch?

What could be the result of fetal head compression?

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