A nurse is checking the reflexes of a newborn. Which of the following actions should the nurse use to elicit the Babinski reflex?

Touch the corner of the newborn's mouth.

Place the newborn supine and apply pressure to the soles of the feet.

Stroke upward on the lateral aspect of the sole of the newborn's foot

Pull the newborn up by the wrist from a supine position.

Answer and Explanation

The Correct Answer is C

(a) Touch the corner of the newborn's mouth:
Touching the corner of the newborn's mouth elicits the rooting reflex, not the Babinski reflex. The rooting reflex causes the newborn to turn their head toward the touch and open their mouth, which helps with feeding.

(b) Place the newborn supine and apply pressure to the soles of the feet:
Applying pressure to the soles of the feet is not a method used to elicit the Babinski reflex. This action might influence other reflexes but not the Babinski.

(c) Stroke upward on the lateral aspect of the sole of the newborn's foot:
This is correct. The Babinski reflex is elicited by stroking upward on the lateral aspect of the sole of the newborn's foot. A positive response is the fanning and extension of the toes, which is normal in newborns.

(d) Pull the newborn up by the wrist from a supine position:
Pulling the newborn up by the wrists from a supine position is used to assess the traction response or pull-to-sit maneuver, which tests the newborn's head control and muscle tone, not the Babinski reflex.

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Correct Answer is C

Explanation

(a) "White blood cell count is an indicator of anemia."
A white blood cell (WBC) count is primarily used to assess for infection or inflammation, not anemia. Anemia is typically evaluated by measuring hemoglobin and hematocrit levels, not WBC count. This statement indicates a misunderstanding of the purpose of the WBC count.

(b) "Urine specific gravity identifies my risk for pregnancy induced hypertension."
Urine specific gravity measures the concentration of urine and is used to assess hydration status and kidney function. It does not directly identify the risk for pregnancy-induced hypertension (PIH). The presence of protein in the urine (proteinuria) would be more indicative of PIH. This statement indicates a misunderstanding of the purpose of the urine specific gravity test.

(c) "Platelet count identifies if I am at risk for bleeding."
This is the correct statement. A platelet count is used to determine the number of platelets in the blood, which are essential for normal blood clotting. A low platelet count (thrombocytopenia) can indicate an increased risk of bleeding, while a high count (thrombocytosis) can be associated with clotting disorders.

(d) "Sedimentation rate checks for signs of cancer."
The erythrocyte sedimentation rate (ESR) measures how quickly red blood cells settle at the bottom of a test tube. It is a nonspecific test used to detect inflammation in the body. While an elevated ESR can be associated with various conditions, including infections, autoimmune diseases, and cancers, it is not specifically used to check for cancer. This statement indicates a misunderstanding of the purpose of the sedimentation rate test.

A. "You should check the identity of individuals who come to remove your baby from the room" B. "We will scan your baby's identification bracelet each time check on him C. "We will match the bracelet on your baby with his footprint record each shift" D. "Your baby will wear an electronic bracelet when he is out of your room

Correct Answer is A

Explanation

(A) "You should check the identity of individuals who come to remove your baby from the room":
It's crucial for parents to verify the identity of anyone who comes to take their baby out of the room. This helps ensure the baby's safety and prevents unauthorized individuals from taking the baby. Hospital staff usually wear identification badges, and parents should be encouraged to ask for and verify this identification.

(B) "We will scan your baby's identification bracelet each time check on him":
While scanning the baby's identification bracelet might be part of some hospital protocols for specific purposes like medication administration or matching mother and baby during certain procedures, it is not typically done every time a nurse checks on the baby. Continuous scanning is not a standard practice and would be logistically impractical.

(C) "We will match the bracelet on your baby with his footprint record each shift":
Matching the baby's bracelet with footprint records each shift is not a standard safety protocol. Footprints are usually taken at birth for records but are not routinely matched every shift. Identification is more reliably ensured through the use of identification bands worn by both the mother and the baby.

(D) "Your baby will wear an electronic bracelet when he is out of your room":
In many hospitals, electronic bracelets are used as a security measure, but they are typically worn by the baby at all times, not just when the baby is out of the room. This measure helps prevent abduction and ensures the baby's location is monitored continuously.

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A nurse is checking the reflexes of a newborn. Which of the following actions should the nurse use to elicit the Babinski reflex?

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