A nurse in the newborn nursery is caring for a group of newborns.
Which of the following newborns requires immediate attention?
A newborn who is 24 hours post-delivery and has not voided.
A newborn who is 18 hours post-delivery and has acrocyanosis.
A newborn who is 24 hours post-delivery and has not passed meconium.
A newborn who is 12 hours post-delivery and has a temperature of 100.5 degrees
The Correct Answer is D
Choice A rationale
While voiding is expected, the normal range for the first void is typically within the first 24 to 48 hours of life. A newborn not voiding at exactly 24 hours warrants continued monitoring, but it is not an immediate emergency unless there are other signs of distress or an obvious obstruction.
Choice B rationale
Acrocyanosis is a normal, transient condition in the newborn characterized by a bluish discoloration of the hands and feet due to sluggish peripheral circulation. It is common for up to 24 hours after birth and does not require immediate intervention, only ongoing assessment to ensure central color is pink.
Choice C rationale
Most healthy newborns pass meconium, the first stool, within the first 24 hours of life, with almost all passing it by 48 hours. A lack of meconium passage at 24 hours requires investigation for potential intestinal issues, such as Hirschsprung's disease or meconium plug, but an elevated temperature signals more acute distress.
Choice D rationale
A temperature of 100.5 degrees F (38.1 degrees C) in a newborn, which is above the normal range (typically 97.7 to 99.5 degrees F or 36.5 to 37.5 degrees C), is a serious finding. Newborns are susceptible to rapid temperature changes, and hyperthermia can indicate sepsis, dehydration, or environmental issues requiring immediate assessment and intervention.
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Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is C
Explanation
Choice A rationale
Although finishing the entire course of antibiotics is crucial for preventing antibiotic resistance and ensuring the complete eradication of the bacteria, it is not the standard criterion for determining when a child can return to school. The infectious period is generally considered to end much sooner after initiating topical treatment.
Choice B rationale
The cessation of eye drainage, or purulent discharge, is a sign of improving infection but is not the sole, definitive indicator for returning to school. The child is generally considered non-infectious and can return to school after a specified period of effective topical antibiotic treatment has been completed.
Choice C rationale
Bacterial conjunctivitis is highly contagious, but contagiousness is rapidly reduced upon starting topical antibiotic treatment. Most school and public health guidelines permit a child to return to school 24 hours after the initiation of topical antibiotic therapy because the risk of transmission is significantly decreased within this timeframe.
Choice D rationale
Requiring a child to be symptom-free for 72 hours is an overly restrictive and generally unnecessary measure for bacterial conjunctivitis managed with topical antibiotics. The standard public health recommendation focuses on the duration of appropriate antibiotic treatment to minimize infectious risk, which is typically 24 hours.
Correct Answer is C
Explanation
Choice A rationale
Pyloric stenosis is a condition in infants where the muscle at the outlet of the stomach (pylorus) thickens, blocking the flow of food. Symptoms include projectile vomiting, visible peristaltic waves, and an olive-shaped mass in the epigastrium. It does not typically cause a large abdominal mass or pink-tinged (hematuria) urine.
Choice B rationale
Nephrotic syndrome is a kidney disorder characterized by excessive protein loss in the urine (proteinuria), leading to severe edema and hypoalbuminemia. While it affects the kidneys and causes significant abdominal swelling due to fluid accumulation (ascites), it usually causes foamy or dark urine, but typically not hematuria and rarely presents as a firm, large mass.
Choice C rationale
Wilms' tumor, or nephroblastoma, is the most common kidney cancer in children, typically presenting between ages 1 and 5. Classic signs include a firm, non-tender, large abdominal mass that rarely crosses the midline, along with microscopic or gross hematuria (pink-tinged urine). Palpation of the mass should be avoided to prevent rupture and potential spread of the tumor cells.
Choice D rationale
Intussusception is a condition where a segment of the intestine telescopes into an adjacent section, causing an obstruction. Key symptoms include sudden, intermittent abdominal pain, drawing up of the knees, and currant jelly-like stools (blood and mucus). It can cause a sausage-shaped mass in the right upper quadrant, but not typically a large, firm mass or pink-tinged urine indicative of isolated hematuria.
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