A nurse is assessing a newborn’s color and oxygenation.
What is the term for the bluish discoloration of the hands and feet that is normal in newborns?
Acrocyanosis
Cyanosis
Pallor
Jaundice
The Correct Answer is A
Acrocyanosis is the term for the bluish discoloration of the hands and feet that is normal in newborns. It is caused by poor peripheral circulation and ineffective temperature regulation. It usually disappears within 24 to 48 hours after birth.
Choice B is wrong because cyanosis is the bluish discoloration of the skin and mucous membranes that indicates inadequate oxygenation.
It is not normal in newborns and requires immediate intervention.
Choice C is wrong because pallor is the paleness of the skin that indicates poor perfusion or anemia.
It is not normal in newborns and requires further evaluation.
Choice D is wrong because jaundice is the yellowish discoloration of the skin and sclera that indicates elevated bilirubin levels.
It is not normal in newborns within the first 24 hours of life and may indicate hemolytic disease or liver dysfunction.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Massaging the fundus stimulates uterine contractions and helps to stop the bleeding.
This is the first action the nurse should take to manage uterine atony.
Choice B is wrong because administering oxytocin is a pharmacological intervention that can be used after massaging the fundus if bleeding persists.
Oxytocin is a hormone that also stimulates uterine contractions and reduces blood loss.
Choice C is wrong because inserting an indwelling urinary catheter is not a priority action for postpartum hemorrhage.
A full bladder can interfere with uterine contractions and cause displacement of the uterus, but it is not the main cause of uterine atony.
Choice D is wrong because starting an IV infusion of lactated Ringer’s solution is a supportive measure that can be used to replace fluid loss and maintain blood pressure in postpartum hemorrhage.
However, it does not address the underlying cause of bleeding and should not be done before massaging the fundus.
Correct Answer is C
Explanation
This is because a low platelet count (<150,000/mm3) indicates thrombocytopenia, which can increase the risk of bleeding and hemorrhage.
The nurse should report this finding to the provider as it may require treatment or transfusion.
Choice A is wrong because hemoglobin 10 g/dL is within the normal range for postpartum women (10-14 g/dL) and does not indicate hemorrhage.
Choice B is wrong because hematocrit 30% is also within the normal range for postpartum women (30-39%) and does not indicate hemorrhage.
Choice D is wrong because white blood cells 12,000/mm3 is slightly elevated but not abnormal for postpartum women, who may have a physiological leukocytosis due to stress, inflammation, or infection.
This finding does not indicate hemorrhage.
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