A nurse is caring for a newborn and assessing newborn reflexes.
To elicit the Babinski reflex, the nurse should take which of the following actions?

Tickle the outer edge of the sole of the newborn’s foot moving up toward the toes.

Turn the newborn’s head quickly to one side.

Hold the newborn vertically allowing one foot to touch the table surface.

Clap near the crib and make a loud noise.

Answer and Explanation

The Correct Answer is A

Choice A rationale

The Babinski reflex is elicited by stroking the outer edge of the sole of the newborn’s foot, moving up toward the toes. This causes the big toe to move upward and the other toes to fan out.

Choice B rationale

Turning the newborn’s head quickly to one side is used to elicit the tonic neck reflex, not the Babinski reflex.

Choice C rationale

Holding the newborn vertically and allowing one foot to touch the table surface is used to elicit the stepping reflex, not the Babinski reflex.

Choice D rationale

Clapping near the crib and making a loud noise is used to elicit the startle (Moro) reflex, not the Babinski reflex.

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Correct Answer is B

Explanation

Choice A rationale

Erythema toxicum is a common, benign rash in newborns but does not cause swelling that crosses suture lines.

Choice B rationale

A caput succedaneum is swelling of the scalp that crosses suture lines and is caused by prolonged pressure on the head during delivery.

Choice C rationale

Mongolian spots are benign, flat, congenital birthmarks with wavy borders and irregular shapes, typically found on the lower back and buttocks, not the head.

Choice D rationale

A cephalhematoma is a collection of blood between the skull bone and its periosteum that does not cross suture lines. .

A. “The glans penis will appear red and have a yellow crust as it heals. Do not remove this.” B. “Ensure the diaper is really tight to keep the gauze attached to the penis.” C. “Notify your pediatrician if your baby has not voided in 24 hours.” D. “Coat the glans penis with petroleum jelly and cover with gauze.” E. “Check for bleeding every 4 hours for the first 24 hours and notify your pediatrician if there is bleeding at the circumcision site.”

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

“The glans penis will appear red and have a yellow crust as it heals. Do not remove this.”
- Essential: This is a normal part of the healing process.
“Ensure the diaper is really tight to keep the gauze attached to the penis.”
- Contraindicated: The diaper should be loose to avoid pressure on the circumcision site.
“Notify your pediatrician if your baby has not voided in 24 hours.”
- Essential: This could indicate a problem that needs medical attention.
“Coat the glans penis with petroleum jelly and cover with gauze.”
- Essential: This helps prevent the diaper from sticking to the circumcision site and aids in healing.
“Check for bleeding every 4 hours for the first 24 hours and notify your pediatrician if there is bleeding at the circumcision site.”
- Essential: Monitoring for bleeding is crucial to ensure there are no complications.

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A nurse is caring for a newborn and assessing newborn reflexes.To elicit the Babinski reflex, the nurse should take which of the following actions?

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Naxlex Comprehensive Predictor Exams

A nurse is caring for a newborn delivered by vaginal birth after 3 hours of pushing.The newborn’s mother asks about the swollen area on her son’s head.After palpation and identification that the swelling does cross the suture line, which of the following is an appropriate response by the nurse?

Correct Answer is B

Explanation

Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"A"}}

Explanation

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A nurse is caring for a newborn and assessing newborn reflexes.
To elicit the Babinski reflex, the nurse should take which of the following actions?