Nokea
Which of the following is an important consideration in positioning a newborn for breastfeeding?
- A. Placing the infant at nipple level facing the breast.
- B. Keeping the infant's head slightly lower than the body.
- C. Using the forefinger and middle finger to support the breast.
- D. Limiting the amount of areola the infant takes into the mouth.
Correct Answer: A
Rationale: The correct answer, A, is important because it ensures proper alignment for effective breastfeeding. Placing the infant at nipple level facing the breast helps the baby latch on correctly, promoting optimal milk transfer. Choice B is incorrect as the infant's head should be in line with the body to prevent swallowing issues. Choice C is incorrect because the fingers should support the breast underneath, not on top. Choice D is also incorrect as the baby should take in a sufficient amount of areola for a deep latch.
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The nursery nurse notes the presence of diffuse edema on a newborn babys head. Review of the birth record indicates that her mother experienced a prolonged labor and difficult childbirth. What action by the nurse is best?
- A. Document the findings in the infants chart.
- B. Measure head circumference every 12 hours.
- C. Prepare to administer IV osmotic diuretics.
- D. Transfer the baby to the NICU for monitoring.
Correct Answer: A
Rationale: Caput succedaneum is diffuse edema that crosses the cranial suture lines and disappears without treatment during the first few days of life. It often is the result of a traumatic or difficult birth. The nurse should document the findings. No other action is needed.
The newborn is having occasional gasping respirations with a heart rate of 90 beats per minute. Skin color is cyanotic with poor muscle tone. Interpreting relevant clinical data in this scenario, what problems are possible? Select all that apply.
- A. The newborn is hypothermic.
- B. The newborn is full term.
- C. The newborn is experiencing respiratory distress.
- D. The newborn is anemic.
Correct Answer: A
Rationale: Gasping respirations, cyanosis, and poor tone suggest respiratory distress and potential hypothermia.
What are the characteristics of a 40-week preterm newborn male's genitalia?
- A. scrotum empty, faint rugae
- B. testes in upper canal, rare rugae
- C. testes down, appropriate rugae
- D. testes pendulous, deep rugae
Correct Answer: C
Rationale: The correct answer is C because at 40 weeks, the testes should be descended into the scrotum. This is a normal developmental milestone for male newborns. Additionally, the presence of appropriate rugae on the scrotum indicates maturity. Choice A is incorrect as the scrotum should not be empty at this stage. Choice B is incorrect as the testes should be in the scrotum, not in the upper canal. Choice D is incorrect as pendulous testes and deep rugae are not typical characteristics of a 40-week preterm male newborn's genitalia.
The nurse is assessing the laboratory report on a 2-day post partum. The woman has had a normal post partum assessment this morning. Which of the following results should the nurse report to the provider?
- A. White blood cells 12,500 cells/mm
- B. Red blood cells 4,500,000 cells/mm
- C. Hematocrit 26%
- D. Hemoglobin 11g/dl
Correct Answer: C
Rationale: A hematocrit of 26% is abnormally low, indicating significant anemia, which requires further evaluation.
What assessment findings indicate abnormal transition in a neonate? Select all that apply.
- A. prolonged apneic episodes
- B. marked pallor
- C. excessive oral secretions
- D. crackles upon auscultation
Correct Answer: C
Rationale: Abnormal transition signs include prolonged apnea, marked pallor, excessive secretions, and crackles.