Nokea
Where would acrocyanosis be assessed on a newborn?
- A. Circumoral area
- B. Brow
- C. Feet
- D. Mucous membrane
Correct Answer: C
Rationale: Acrocyanosis is the slightly blue appearance of the hands and feet that is caused by poor circulation. It can last for 7 to 10 days in the newborn.
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A new mother asks for advice on how to quiet her fussy newborn. Which responses would be appropriate to suggest to the mother?
- A. Prewarm the crib sheets with a hot water bottle
- B. Swaddle the newborn tightly in a receiving blanket
- C. Place the baby in a larger crib or infant bed
- D. Offer a pacifier or allow the infant to suckle at the breast
- E. Take the infant for a ride in the car
Correct Answer: A,B,D,E
Rationale: Oftentimes, infants are comforted by warm sheets. Infants tend to like to be swaddled snugly. Many infants find comfort sucking a pacifier; breast-fed infants can suckle at the breast. Car rides are often soothing for infants. A large sleeping space is not soothing for infants. The opposite is true. A small sleeping space, such as a bassinette, tends to comfort a fussy baby.
Before initially feeding an infant what reflex should the nurse assess?
- A. Moro reflex
- B. Rooting reflex
- C. Babinski reflex
- D. Swallow reflex
Correct Answer: D
Rationale: The nurse should verify that the infant is able to swallow normally before feeding.
Which finding should the nurse suspect as abnormal in the newborn during the initial assessment?
- A. Eyes crossed at times
- B. Persistent high-pitched cry
- C. Arms and legs flexed
- D. Slight bluish tinge of the extremities
Correct Answer: B
Rationale: A high-pitched cry may indicate neurologic problems. Occasional crossing of the eyes, flexing of the arms and legs, and a bluish tinge of the extremities are all considered normal assessment findings in the newborn.
After delivery of a 9-lb baby the nurse assesses a perineal laceration extending through the muscles of the perineum. The nurse records this as a ___-degree laceration.
Correct Answer: second
Rationale: A second-degree laceration extends through the superficial tissues into the muscles of the perineum.
The nurse is giving a bath demonstration for a group of new mothers. What should be included in the demonstration?
- A. Apply baby powder generously to keep baby dry.
- B. Cleanse perineum from front to back.
- C. Use scented soap to make baby smell good.
- D. Partially submerge head in water when shampooing.
Correct Answer: B
Rationale: The perineum should be cleansed by wiping from the anterior to the posterior. Excessive use of powders and scented soaps can irritate the skin. The head should not be submerged in water.