A newborn born two hours ago at 36 weeks gestation has noted findings.

Bruising noted over occiput.

Yellowish hue on sclera and skin blanching.

Transcutaneous bilirubin level 12.5 mg/dL (less than 12 mg/dL).

Phototherapy initiated at 08:45. . .

Answer and Explanation

Correct Answer : B,C,D

Choice A rationale

Occipital bruising typically results from birth trauma due to compressive forces during delivery. While notable, it isn’t necessarily pathological in the context of common neonatal findings.

Choice B rationale

Yellowish sclera and blanching skin indicate neonatal jaundice from elevated bilirubin levels. Hyperbilirubinemia arises due to immature hepatic conjugation processes, necessitating close monitoring for kernicterus risk.

Choice C rationale

A transcutaneous bilirubin level of 12.5 mg/dL exceeds normal (<12 mg/dL) for newborns, indicating hyperbilirubinemia. It reflects excessive hemolysis or liver immaturity requiring therapeutic interventions like phototherapy.

Choice D rationale

Phototherapy at 08: targets bilirubin breakdown into water-soluble forms for excretion. Blue light exposure facilitates reduced serum bilirubin levels, mitigating neonatal jaundice complications promptly. .

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Correct Answer is C

Explanation

Choice A rationale

Postpartum depression involves persistent sadness and impaired functioning, typically lasting longer than two weeks. This client’s symptoms suggest a more transient condition.

Choice B rationale

The taking-in phase refers to the period immediately postpartum when the mother focuses on her own needs, not emotional instability as described.

Choice C rationale

Postpartum blues, characterized by mood swings, crying spells, and irritability, typically resolve within two weeks postpartum and are linked to hormonal changes.

Choice D rationale

The taking-hold phase involves active learning about infant care and maternal adjustment, not the emotional lability described in this scenario.

A. BUN level of 30 mg/dL (normal range: 10 to 20 mg/dL). B. Hemoglobin level of 9.9 g/dL (normal range: 11 to 16 g/dL). C. Serum uric acid level of 2.5 mg/dL (normal range: 2.7 to 7.3 mg/dL). D. Casual blood glucose level of 228 mg/dL (normal range: less than 200 mg/dL).

Correct Answer is A

Explanation

Choice A rationale

A BUN level of 30 mg/dL is above the normal range of 10 to 20 mg/dL. Elevated BUN is consistent with renal involvement in preeclampsia, which is caused by vascular constriction and reduced renal perfusion.

Choice B rationale

A hemoglobin level of 9.9 g/dL is below the normal gestational range of 11 to 16 g/dL. While anemia might occur, it is not a hallmark feature of preeclampsia itself.

Choice C rationale

A serum uric acid level of 2.5 mg/dL is below the normal range of 2.7 to 7.3 mg/dL. Elevated uric acid is more typical in preeclampsia due to impaired renal function.

Choice D rationale

A casual blood glucose level of 228 mg/dL exceeds the normal range of less than 200 mg/dL. Hyperglycemia is not directly linked to preeclampsia, suggesting an independent metabolic disturbance.

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A newborn born two hours ago at 36 weeks gestation has noted findings.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is assessing a client who gave birth 1 week ago.The client states, "I don't know what's wrong.I love my baby, but I feel so let down and I seem to cry for no reason.”. The nurse should identify that the client is experiencing which of the following emotional responses to birth?

Correct Answer is C

Explanation

A nurse is reviewing a laboratory report for a client who is at 33 weeks of gestation and has preeclampsia.Which of the following laboratory results should the nurse expect?

Correct Answer is A

Explanation

For each of the following potential antihypertensive medications, indicate whether it is recommended or not recommended for use in a pregnant client.

A nurse is assessing a newborn who is 48 hr old and has a maternal history of methadone use during pregnancy.Which of the following manifestations should the nurse identify as an indication of neonatal abstinence syndrome?

A nurse is assessing a newborn whose mother had gestational diabetes mellitus.Which of the following findings should the nurse identify as a manifestation of hypoglycemia?

A nurse is admitting a client who is at 35 weeks of gestation and is experiencing mild vaginal bleeding due to placenta previa.Which of the following actions should the nurse plan to take?

A nurse is providing teaching to a client who has fibrocystic breast changes and is experiencing breast discomfort during menstruation.Which of the following instructions should the nurse include?

A nurse is providing teaching to a group of clients about risk factors for ovarian cancer.Which of the following risk factors should the nurse include? (Select all that apply.)

A nurse is providing teaching to a client who is at 34 weeks of gestation and is scheduled for a nonstress test.Which of the following statements should the nurse plan to make?

A nurse is caring for a client.Which of the following interventions should the nurse perform? (Click on the exhibit tabs for additional information about the client.There are three tabs that contain separate categories of data.)