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 C

Explanation

Choice A rationale

Applying a 1-2 cm ribbon from outer to inner canthus is incorrect because it increases the risk of contamination and infection by moving from a less clean area to a more clean area.

Choice B rationale

Applying a 2-3 inch ribbon from inner to outer canthus is incorrect because the length of the ribbon is too long and the direction is not recommended for preventing contamination.

Choice C rationale

Applying a 1-2 cm ribbon from inner to outer canthus is correct as it minimizes the risk of contamination by moving from a cleaner area to a less clean area, ensuring proper application of the ointment.

Choice D rationale

Applying a 1-2 inch ribbon to the upper eyelid is incorrect because the upper eyelid is not the recommended site for application, and the length of the ribbon is too long.

Correct Answer is ["0.5"]

Explanation

Step 1 is to calculate the volume to administer.

Step 1: mg ÷ (1 mg ÷ 0.5 mL) = 0.5 mL. The nurse should administer 0.5 mL.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer 0.5% Erythromycin ophthalmic ointment to a newborn.Which route and dose should the nurse apply?

Correct Answer is C

Explanation

A nurse is preparing to administer 1 mg Phytonadione to a neonate. The medication is available in 1 mg/0.5 mL. How much should the nurse administer? (Round to the nearest tenth. Use a leading zero when applicable. Do not use a trailing zero.)

Correct Answer is ["0.5"]

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?