A nurse in the newborn nursery is collecting data about a newborn's Moro reflex. Which of the following actions should the nurse take to elicit this reflex?

Turn the newborn's head quickly to one side while they are sleeping.

Place a finger in the newborn's palm.

Clap hands after laying the newborn on a flat surface.

Hold the newborn upright with one foot touching the crib surface

None

Answer and Explanation

The Correct Answer is C

A. Turn the newborn's head quickly to one side while they are sleeping: This action does not elicit the Moro reflex. The Moro reflex is a response to a sudden loss of support, not a head-turning motion.

B. Place a finger in the newborn's palm: This action would elicit the palmar grasp reflex, not the Moro reflex.

C. Clap hands after laying the newborn on a flat surface: The Moro reflex is triggered by a sudden, loud noise or movement, such as clapping hands. This response causes the newborn to extend and then quickly flex the arms, a characteristic sign of the reflex.

D. Hold the newborn upright with one foot touching the crib surface: This action is not related to the Moro reflex. The stepping reflex is elicited by holding the newborn upright with their feet touching a surface, not the Moro reflex.

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Correct Answer is B

Explanation

A. Hemoglobin (Hgb) of 12 g/dL is within the normal range for a pregnant individual and does not typically require notification of the provider.
B. Platelet count of 90,000/mm3 is below the normal range (typically 150,000 to 400,000/mm3) and may indicate thrombocytopenia, which can be associated with conditions such as
preeclampsia or HELLP syndrome. The nurse should notify the provider about this result.

C. Hematocrit of 37% is within the normal range for a pregnant individual and does not typically require notification of the provider.
D. Creatinine level of 0.7 mg/dL is within the normal range and does not typically require notification of the provider.

A. Serum calcium 12.5 mg/dL B. BUN 16 mg/dL C. Serum potassium 4.6 mEq/L D. WBC count 8,000/mm3

Correct Answer is A

Explanation

A. An elevated serum calcium level (hypercalcemia) can indicate a complication of total parenteral nutrition, such as hypercalcemia resulting from excess calcium supplementation in the
TPN solution, which can lead to complications such as renal calculi and cardiac dysrhythmias.
B. The blood urea nitrogen (BUN) level within the normal range does not indicate a complication related to total parenteral nutrition.
C. The serum potassium level within the normal range does not indicate a complication related to total parenteral nutrition.
D. A normal white blood cell (WBC) count does not indicate a complication related to total parenteral nutrition.

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A nurse in the newborn nursery is collecting data about a newborn's Moro reflex. Which of the following actions should the nurse take to elicit this reflex?

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