A nurse is collecting data from a newborn who is 48-hr old. Which of the following findings should the nurse report to the provider?
Erythema toxicum
Mongolian spot
Telangiectatic nevi
jaundice skin and yellow tinge to the sclera
The Correct Answer is D
Choice A rationale; Erythema toxicum is a common rash that appears in many newborns and is not a cause for concern. It presents as small red bumps or pustules on the skin and usually resolves on its own without treatment.
Choice B rationale: A Mongolian spot is a birthmark that appears as a bluish-gray or bruise-like patch on the baby's skin, often on the back or buttocks. It is a benign condition and does not require any medical intervention.
Choice C rationale: Telangiectatic nevi, also known as "stork bites" or "angel kisses," are flat, pink, or red birthmarks that are common in newborns. They are usually found on the eyelids, forehead, and back of the neck. These birthmarks are harmless and typically fade over time without treatment.
Choice D rationale: Jaundice is a common condition in newborns and is caused by elevated levels of bilirubin in the blood. In most cases, mild jaundice is not harmful and resolves on its own. However, if the baby's skin and sclera (white part of the eyes) show significant yellowing, it may indicate a higher level of bilirubin, which can lead to complications if not properly managed. Therefore, the nurse should report this finding to the provider for further evaluation and appropriate treatment if necessary.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A rationale: Placing the infant in a prone position (lying face down) after feeding is not recommended for a baby with gastroesophageal reflux. The prone position can increase the risk of choking and is not helpful in managing reflux.
Choice B rationale: For an infant with gastroesophageal reflux, placing the baby in an upright position after feeding can help prevent or reduce reflux episodes. Keeping the infant in an upright position allows gravity to assist in keeping stomach contents down and reduces the likelihood of reflux into the esophagus.
Choice C rationale: Placing the infant on the right side after feeding is also not recommended for managing gastroesophageal reflux. The right-side position may not be as effective in preventing reflux as the upright position.
Choice D rationale: Placing the infant on the left side after feeding is not the preferred position for managing gastroesophageal reflux. The left-side position may not be as effective in preventing reflux as the upright position.
Correct Answer is D
Explanation
Choice A rationale: While smoking during pregnancy can have adverse effects on both the mother and the baby, it is not the most common risk factor for placental abruption.
Choice B rationale: Maternal battering, or experiencing domestic violence, can have serious consequences for the pregnant woman and her unborn baby, but it is not the most common risk factor for placental abruption.
Choice C rationale: Maternal cocaine use during pregnancy can lead to various complications, but it is not the most common risk factor for placental abruption.
Choice D rationale: Maternal hypertension is the most common risk factor for placental abruption. Placental abruption is a serious condition where the placenta separates from the uterine wall before delivery, leading to potential complications for both the mother and the baby. Hypertension can cause changes in blood vessels that increase the risk of placental abruption.
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