A macrosomic infant in the newborn nursery is being observed for a possible fractured clavicle. For which would the nurse assess? Select all that apply.
asymmetrical movement
bruising over area
edema present
facial grimacing with movement
positive Babinski reflex
Correct Answer : A,B,C,D
A. Asymmetrical movement may indicate discomfort or restricted mobility due to a fractured clavicle.
B. Bruising over the area of the clavicle may suggest trauma and could be associated with a fracture.
C. Edema (swelling) over the fractured clavicle may be present due to inflammation and tissue injury.
D. Facial grimacing with movement could indicate pain or discomfort associated with a fractured clavicle.
E. A positive Babinski reflex is unrelated to a fractured clavicle and would not be directly assessed for this condition.
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Related Questions
Correct Answer is D
Explanation
A. While positioning is important for phototherapy, the supine position may not always be necessary.
B. Restricting fluid intake may lead to dehydration, which is not appropriate, especially during phototherapy.
C. Ensuring the newborn is covered or clothed may interfere with the effectiveness of phototherapy.
D. Covering the newborn's eyes with protective shields or patches while under the bililights helps prevent damage to the eyes from the bright light.
Correct Answer is C
Explanation
A. Surgery may be considered in severe cases or if conservative treatments fail, but it is not typically the first-line treatment for Erb's palsy.
B. Immobilization may be part of the treatment plan in some cases, but it is usually accompanied by physical therapy rather than being the sole treatment.
C. Physical therapy is often the initial treatment for Erb's palsy, focusing on gentle stretching exercises, range of motion activities, and strengthening exercises to improve muscle function and joint mobility.
D. While Erb's palsy may improve over time for some infants, early intervention with physical therapy is generally recommended to optimize outcomes and prevent long- term complications.
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