Nokea
Infants who develop cephalohematoma are at an increased risk for
- A. infection.
- B. jaundice.
- C. caput succedaneum.
- D. erythema toxicum.
Correct Answer: B
Rationale: The correct answer is B: jaundice. Cephalohematoma is a collection of blood between the skull and periosteum of a newborn, often caused by birth trauma. This blood breakdown can lead to an increase in bilirubin levels, causing jaundice. Infection (choice A) is not directly associated with cephalohematoma. Caput succedaneum (choice C) is a scalp swelling that resolves on its own and is not linked to cephalohematoma. Erythema toxicum (choice D) is a benign rash common in newborns and is not related to cephalohematoma or jaundice.
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During an assessment of a 12-hour-old newborn, the nurse notices pale pink spots on the nape of the neck. How does the nurse document this finding?
- A. nevus vasculosus
- B. Mongolian spots
- C. nevus flammeus
- D. telangiectatic nevi
Correct Answer: C
Rationale: Nevus flammeus, also known as salmon patches, are common vascular markings often seen on the nape of the neck.
What action by the nurse takes priority in safeguarding a neonates safety and well-being?
- A. Ensuring that the baby wears an abduction alarm
- B. Keeping the baby with the mother at all times
- C. Requiring visitors to the unit to wear identification
- D. Providing proper identification and constant surveillance
Correct Answer: A
Rationale: Careful and continuous monitoring of infants and proper identification per agency protocol is the best way to ensure a babys safety and well-being. Some institutions may use abduction alarms. Keeping the baby with the mother at all times may not always be possible. Proper identification of visitors is important
What characteristics are directly related to the newborn’s decreased ability to maintain thermal stability?
- A. A neonate has decreased subcutaneous fat and a large body surface-to-weight ratio.
- B. The blood vessels in the neonate are farther from the skin than those of an adult.
- C. Newborns are unable to rely on brown adipose tissue for heat production.
- D. The newborn prefers to be in constant motion, increasing the surface area exposed to the environment.
Correct Answer: A
Rationale: Newborns have less subcutaneous fat and a higher surface-to-weight ratio, making thermoregulation challenging.
The nurse is caring for a patient who has been diagnosed as having a fetal death. The nurse is aware of the possible causes of intrapartum fetal death. How can the nurse explain the potential causes of IPFD to the patient?
- A. We will always find the cause of fetal death with an autopsy.
- B. Infection is never a cause of fetal death.
- C. Umbilical cord entanglement can cause fetal death.
- D. Congenital anomalies cause growth restriction, not fetal death.
Correct Answer: C
Rationale: Umbilical cord entanglement is a recognized cause of intrapartum fetal death (IPFD). While congenital anomalies may lead to complications, they are not typically direct causes of IPFD. Infections can also contribute to fetal death, making option B incorrect. Autopsies help identify causes but do not guarantee definitive answers, so A is incorrect.
The nurse is assigned to the room of a 15-year-old person who gave birth to a newborn 72 hours ago. Why is this newborn a perfect candidate for the Brazelton assessment?
- A. This parent-newborn couplet is at risk for delayed attachment.
- B. The newborn is likely going home soon.
- C. The EHR is prompting her to do so.
- D. The infant is likely withdrawing from a substance.
Correct Answer: A
Rationale: Delayed attachment may occur in younger parents, making the Brazelton assessment valuable for evaluating bonding.