Nursing Care of the Newborn

Nursing Care of the Newborn Related

Review Nursing Care of the Newborn related questions and content

A new mother and father are inspecting their baby after the nurse brings the infant to them. The mother wants to know why her baby has bruises on the buttocks area. Which statement should be made by the nurse?

  • A. Bruises are common after a traumatic delivery. I will ask the physician to come discuss the delivery.'
  • B. These areas are called blue/gray macules and are common in certain ethnic groups, but will disappear around 3 years of age.'
  • C. These are not bruises; these spots are birthmarks and are usually a permanent impairment.'
  • D. The previous nurse did not report these findings. Who else has been in the room with the baby?'
Correct Answer: B

Rationale: The correct answer is B because blue/gray macules, also known as Mongolian spots, are common in certain ethnic groups, especially in babies with darker skin tones. These marks typically appear on the buttocks and lower back and usually fade away by around 3 years of age. This explanation reassures the parents that the marks are not bruises from trauma but rather a normal and harmless skin pigmentation variation.

Choices A, C, and D are incorrect because:
A: This statement implies a traumatic delivery, which may cause unnecessary worry for the parents. It also deflects responsibility by suggesting involving the physician without providing a clear explanation.
C: This statement misidentifies the marks as birthmarks, which are different from Mongolian spots. It also incorrectly suggests they are a permanent impairment, causing unnecessary concern.
D: This statement is confrontational and shifts the focus away from addressing the parents' concerns. It does not provide any explanation or reassurance about the baby's condition.

You may also like to solve these questions

The nurse is completing an initial assessment of the newborn. The newborn’s ears appear to be parallel to the outer and inner canthus of the eye. How does the nurse document the ear placement?

  • A. low set
  • B. high set
  • C. a normal position
  • D. facial paralysis
Correct Answer: C

Rationale: Ears positioned parallel to the outer and inner canthus are considered normal.

A term infants initial blood glucose level is 42 mg/dL. What action by the nurse is most appropriate?

  • A. Document the findings in the infants chart.
  • B. Encourage the mother to initiate breastfeeding.
  • C. Prepare to administer intravenous glucose.
  • D. Recheck the blood glucose in 2 hours.
Correct Answer: A

Rationale: For term infants

The nurse is completing an initial assessment of the newborn. The newborn's ears appear to be parallel to the outer and inner canthus of the eye. How does the nurse document the ear placement?

  • A. low set
  • B. high set
  • C. a normal position
  • D. facial paralysis
Correct Answer: C

Rationale: Step 1: Observe the newborn's ears are parallel to the outer and inner canthus of the eye.
Step 2: Compare the observed ear placement to the standard positioning.
Step 3: If the ears align with the eye canthus, document as "a normal position" (Choice C).
Rationale: Parallel ear position indicates normal development. Low set (Choice A) or high set (Choice B) ears suggest abnormalities. Facial paralysis (Choice D) is not related to ear placement in this context.

What would be a warning sign of ineffective adaptation to extrauterine life if noted when assessing a 24-hour-old breastfed newborn before discharge?

  • A. Apical heart rate of 90 beats/min, slightly irregular, when awake and active
  • B. Acrocyanosis
  • C. Harlequin sign
  • D. Weight loss representing 5% of the newborn’s birth weight
Correct Answer: A

Rationale: A low heart rate and irregularity could indicate poor cardiac function or other underlying issues. Acrocyanosis and mild weight loss are normal findings.

When the nurse determines they have a high-risk newborn and birthing person in their care, what can they do to mitigate the situation?

  • A. Document in the chart.
  • B. Reassure the parent that everything will be fine.
  • C. Refer the couplet to social work for early intervention.
  • D. Refer to a pediatric health-care provider for well-baby checkup.
Correct Answer: C

Rationale: Referring to social work ensures early intervention and support for high-risk situations.

Copyright © 2025 Nokea. All rights reserved.