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. Contact the provider to prescribe more pain medication for the client. B. Teach the client relaxation techniques for treatment of acute pain. C. Document the client's reaction to the administration of medication. D. Reevaluate the client's response to the medication in 30 min.

Correct Answer is D

Explanation

A. Contacting the provider to prescribe more pain medication may be necessary if the client's pain is not adequately controlled; however, reevaluation of the client's response to the initial dose should be done first.
B. Teaching relaxation techniques for acute pain management may be helpful, but it is not the priority at this moment when the client's pain is not adequately controlled.
C. Documenting the client's reaction to the medication is important but should not delay immediate action to address the client's unrelieved pain.
D. Reevaluating the client's response to the medication is the priority to determine if additional interventions are needed to manage the client's pain effectively.

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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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Naxlex Comprehensive Predictor Exams

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Explanation

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Correct Answer is D

Explanation

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